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NPI Code Detail

MEDICARE: BUKOLA OLALEYE LCSW,LCASA

MEDICARE: BUKOLA OLALEYE LCSW,LCASA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerC012360NC

General Provider Information

NPI Number : 1942730643
Entity Type Code : Individual
Provider Name (Legal Business Name) : BUKOLA OLALEYE LCSW,LCASA
Provider Business Mailing Address
First Line : 4801 GLENWOOD AVE STE 200
Second Line :
City : RALEIGH
State : NC
Zip : 27612-3857
Country : US
Telephone Number : 919-675-1764
Fax Number : 919-591-0253
Provider Business Practice Location Address
First Line : 4801 GLENWOOD AVE STE 200
Second Line :
City : RALEIGH
State : NC
Zip : 27612-3857
Country : US
Telephone Number : 919-675-1764
Fax Number : 919-591-0253
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2017
Last Update Date : 12/18/2023

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