Provider Demographics
NPI:1326520917
Name:ODETOYINBO, YEMISI (LMSW)
Entity Type:Individual
Prefix:
First Name:YEMISI
Middle Name:
Last Name:ODETOYINBO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 E JEFFERSON AVE APT 810
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4171
Mailing Address - Country:US
Mailing Address - Phone:313-319-1218
Mailing Address - Fax:
Practice Address - Street 1:2170 E JEFFERSON AVE APT 810
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4171
Practice Address - Country:US
Practice Address - Phone:313-319-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011154071041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical