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General NPI Number Information
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NPI Number | 1932078904
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Entity Type | Individual
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Provider Name | GRACE TOLUWALOPE AJISAFE
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Gender | Female
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Dates
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Enumeration Date | 10/30/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 258 NAJOLES RD
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City | MILLERSVILLE
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State | MD
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Zip | 21108-2676
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Country | US
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Telephone | 855-935-3691
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Fax |
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Provider Business Mailing Address
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Address Line | 7120 SAMUEL MORSE DR STE 150
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City | COLUMBIA
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State | MD
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Zip | 21046-3420
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB1364108
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License Number State | MD
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