Provider Demographics
NPI:1093349649
Name:BELLO, OLUFUNMILOLA RUTH (MS)
Entity Type:Individual
Prefix:
First Name:OLUFUNMILOLA
Middle Name:RUTH
Last Name:BELLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 LONETREE PT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-8695
Mailing Address - Country:US
Mailing Address - Phone:404-246-9232
Mailing Address - Fax:
Practice Address - Street 1:3004 LONETREE PT
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-8695
Practice Address - Country:US
Practice Address - Phone:404-246-9232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-22
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000000000101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor