Healthcare Provider Details

I. General information

NPI: 1013072909
Provider Name (Legal Business Name): JOSHUA NOSA OKUNDAYE PH.D., LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14526 CHURCH ST
UPPER MARLBORO MD
20772-3040
US

IV. Provider business mailing address

14526 CHURCH ST
UPPER MARLBORO MD
20772-3040
US

V. Phone/Fax

Practice location:
  • Phone: 301-574-4200
  • Fax:
Mailing address:
  • Phone: 301-574-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number08340
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: