Provider Demographics
NPI:1083227177
Name:ABE-FAPOHUNDA, ADEBOLA (PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ADEBOLA
Middle Name:
Last Name:ABE-FAPOHUNDA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13209 WATER FOWL WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7006
Mailing Address - Country:US
Mailing Address - Phone:240-643-0403
Mailing Address - Fax:510-327-7629
Practice Address - Street 1:13209 WATER FOWL WAY
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-7006
Practice Address - Country:US
Practice Address - Phone:301-395-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00241829981363LP0808X
AZ248345363LP0808X
MI470372385363LP0808X
NH083460-23363LP0808X
MDR166694363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health