Provider Demographics
NPI:1164635595
Name:OLEWUNNE, MARGIE DIXON
Entity Type:Individual
Prefix:MRS
First Name:MARGIE
Middle Name:DIXON
Last Name:OLEWUNNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 GORNIAK DR
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-1315
Mailing Address - Country:US
Mailing Address - Phone:732-316-9240
Mailing Address - Fax:
Practice Address - Street 1:570 LEE ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3053
Practice Address - Country:US
Practice Address - Phone:732-442-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW05018500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health