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General NPI Number Information
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NPI Number | 1366355091
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Entity Type | Individual
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Provider Name | YETUNDE DEJA OMITOGUN LGPC
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Gender | Female
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Dates
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Enumeration Date | 09/24/2026
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Last Update Date | 09/24/2026
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Provider Practice Location Address
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Address Line | 808 OLNEY SANDY SPRING RD STE 208
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City | SANDY SPRING
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State | MD
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Zip | 20860-1075
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Country | US
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Telephone | 410-635-1184
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Fax | 410-630-8087
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Provider Business Mailing Address
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Address Line | 1997 ANNAPOLIS EXCHANGE PKWY STE 300
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3273
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Country | US
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Telephone | 410-635-1130
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Fax | 410-630-8087
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 200012710
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License Number State | DC
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