Provider Demographics
NPI:1477144087
Name:OGUNKUA, OLUBUKOLA A (MD, MPH, MHS, LPC)
Entity Type:Individual
Prefix:DR
First Name:OLUBUKOLA
Middle Name:A
Last Name:OGUNKUA
Suffix:
Gender:F
Credentials:MD, MPH, MHS, LPC
Other - Prefix:DR
Other - First Name:BUKOLA
Other - Middle Name:A
Other - Last Name:OGUNKUA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH, MHS, LPC
Mailing Address - Street 1:1030 THOMAS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2857
Mailing Address - Country:US
Mailing Address - Phone:267-608-7548
Mailing Address - Fax:
Practice Address - Street 1:1030 THOMAS RD STE 100
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2857
Practice Address - Country:US
Practice Address - Phone:267-608-7548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007564101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty