Provider Demographics
NPI:1376660902
Name:OYEBANJO, CARISA LORETTA I (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CARISA
Middle Name:LORETTA
Last Name:OYEBANJO
Suffix:I
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12027 SWALLOW FALLS CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7814
Mailing Address - Country:US
Mailing Address - Phone:301-572-8168
Mailing Address - Fax:
Practice Address - Street 1:12027 SWALLOW FALLS CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7814
Practice Address - Country:US
Practice Address - Phone:301-572-8168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health