Healthcare Provider Details

I. General information

NPI: 1962069732
Provider Name (Legal Business Name): OLUTOYOSI AJAYI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9440 MARLBORO PIKE SUITE 100
UPPER MARLBORO MD
20772
US

IV. Provider business mailing address

3300 HAMPTON POINT DR APT A
SILVER SPRING MD
20904-4841
US

V. Phone/Fax

Practice location:
  • Phone: 240-243-9599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP13665
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: