Provider Demographics
NPI:1225456346
Name:OKUNNUGA, JASEN DAYO
Entity Type:Individual
Prefix:
First Name:JASEN
Middle Name:DAYO
Last Name:OKUNNUGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 STOCKTON ST APT 456
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-4189
Mailing Address - Country:US
Mailing Address - Phone:818-424-6425
Mailing Address - Fax:
Practice Address - Street 1:700 STOCKTON ST APT 456
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-4189
Practice Address - Country:US
Practice Address - Phone:818-424-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-05
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health