Provider Demographics
NPI:1467100503
Name:FAWUMI, TAYLA
Entity Type:Individual
Prefix:
First Name:TAYLA
Middle Name:
Last Name:FAWUMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLA
Other - Middle Name:
Other - Last Name:HALMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LGPC
Mailing Address - Street 1:337 GREEN MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1169
Mailing Address - Country:US
Mailing Address - Phone:301-204-0427
Mailing Address - Fax:
Practice Address - Street 1:15480 ANNAPOLIS RD STE 202
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1803
Practice Address - Country:US
Practice Address - Phone:301-204-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty