Healthcare Provider Details

I. General information

NPI: 1467360412
Provider Name (Legal Business Name): ABIMBOLA GLORIA AFOLAYAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CONSTITUTION DR FL 1
BEDFORD NH
03110-6042
US

IV. Provider business mailing address

9 WILLEY RD
DURHAM NH
03824-3119
US

V. Phone/Fax

Practice location:
  • Phone: 603-637-3485
  • Fax: 603-709-6753
Mailing address:
  • Phone: 603-637-3485
  • Fax: 603-709-6753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ABIMBOLA AFOLAYAN
Title or Position: OWNER
Credential:
Phone: 307-400-3020