Provider Demographics
NPI:1306404058
Name:ADEBULE, FAITH OLUBUKOLA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FAITH
Middle Name:OLUBUKOLA
Last Name:ADEBULE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:OLUBUKOLA
Other - Last Name:AREMU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1740 CARRIAGE LAMP CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-6802
Mailing Address - Country:US
Mailing Address - Phone:443-529-6091
Mailing Address - Fax:
Practice Address - Street 1:1740 CARRIAGE LAMP CT
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-6802
Practice Address - Country:US
Practice Address - Phone:443-529-6091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MDLC8788101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist