Healthcare Provider Details

I. General information

NPI: 1770051849
Provider Name (Legal Business Name): OLATOKUNBO ADEDAYO OGUNYILEKA LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S 5TH ST
RICHMOND VA
23219-3825
US

IV. Provider business mailing address

107 S 5TH ST
RICHMOND VA
23219-3825
US

V. Phone/Fax

Practice location:
  • Phone: 804-819-4000
  • Fax: 804-819-5221
Mailing address:
  • Phone: 804-819-4000
  • Fax: 804-819-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007864
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: