Healthcare Provider Details

I. General information

NPI: 1487572301
Provider Name (Legal Business Name): OLUWATIMILEHIN OLUWADAMILARE MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IYANUOLUWA OLUWADAMILARE

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15131 ELLICOTT DR 209
MIDLOTHIAN VA
23114-6837
US

IV. Provider business mailing address

15131 ELLICOTT DR APT 209
MIDLOTHIAN VA
23114-6837
US

V. Phone/Fax

Practice location:
  • Phone: 856-534-1662
  • Fax:
Mailing address:
  • Phone: 856-534-1662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: