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General NPI Number Information
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NPI Number | 1114601358
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Entity Type | Individual
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Provider Name | OLUTOYIN FASOSIN LGPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 8894 STANFORD BLVD
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City | COLUMBIA
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State | MD
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Zip | 21045-4794
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Country | US
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Telephone | 443-574-5957
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Fax |
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Provider Business Mailing Address
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Address Line | 3375 ELLICOTT CENTER DR # 2361
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-4100
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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