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General NPI Number Information
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NPI Number | 1144936824
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Entity Type | Individual
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Provider Name | OLUSHOLA ADEWUMI PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/26/2023
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 5613 OAKLEY INDUSTRIAL BLVD APT 7308
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City | FAIRBURN
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State | GA
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Zip | 30213-4553
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Country | US
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Telephone | 646-327-0118
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Fax |
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Provider Business Mailing Address
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Address Line | 5613 OAKLEY INDUSTRIAL BLVD APT 7308
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City | FAIRBURN
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State | GA
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Zip | 30213-4553
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Country | US
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Telephone | 646-327-0118
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 810008745
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7266
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License Number State | MD
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