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General NPI Number Information
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NPI Number | 1568012771
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Entity Type | Individual
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Provider Name | OMOLOLA FESTUS ADEDAYO LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/19/2019
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Last Update Date | 06/08/2025
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Provider Practice Location Address
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Address Line | 12 CARRIAGE WALK CT
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City | BALTIMORE
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State | MD
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Zip | 21234-1425
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Country | US
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Telephone | 301-728-2383
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Fax |
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Provider Business Mailing Address
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Address Line | 12 CARRIAGE WALK CT
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City | PARKVILLE
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State | MD
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Zip | 21234-1425
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Country | US
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Telephone | 301-728-2383
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 10992
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 24332
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License Number State | MD
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