Healthcare Provider Details

I. General information

NPI: 1487019626
Provider Name (Legal Business Name): OLANREWAJU FELIX OLOWOYEYE LCASA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E MORGAN ST
RALEIGH NC
27601-1410
US

IV. Provider business mailing address

4704 COURTNEY LN APT C
RALEIGH NC
27616-5251
US

V. Phone/Fax

Practice location:
  • Phone: 919-835-1888
  • Fax:
Mailing address:
  • Phone: 919-673-9283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22316
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: