Healthcare Provider Details

I. General information

NPI: 1831494400
Provider Name (Legal Business Name): PRINCE OLASUNKANMI ENIOLA NA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E OLIVE ST SOUND MENTAL HEALTH
SEATTLE WA
98122-2735
US

IV. Provider business mailing address

1600 E OLIVE ST SOUND MENTAL HEALTH
SEATTLE WA
98122-2735
US

V. Phone/Fax

Practice location:
  • Phone: 206-302-2200
  • Fax: 206-302-2210
Mailing address:
  • Phone: 206-302-2200
  • Fax: 206-302-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60130541
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA00197940
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: