Provider Demographics
NPI:1073276655
Name:ODUYEBO, ADEMOLA MOSES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ADEMOLA
Middle Name:MOSES
Last Name:ODUYEBO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W MILL AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-2664
Mailing Address - Country:US
Mailing Address - Phone:202-236-5051
Mailing Address - Fax:
Practice Address - Street 1:121 W MILL AVE
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-2664
Practice Address - Country:US
Practice Address - Phone:202-236-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health