Provider Demographics
NPI:1477689222
Name:TOMORI, MORIDUNNUOLUWA O (MS)
Entity Type:Individual
Prefix:MRS
First Name:MORIDUNNUOLUWA
Middle Name:O
Last Name:TOMORI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:IDUNNUOLUWA
Other - Middle Name:O
Other - Last Name:ADEMOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:257 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-1510
Mailing Address - Country:US
Mailing Address - Phone:812-346-2872
Mailing Address - Fax:812-346-4172
Practice Address - Street 1:257 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-1510
Practice Address - Country:US
Practice Address - Phone:812-346-2872
Practice Address - Fax:812-346-4172
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health