Provider Demographics
NPI:1548767635
Name:OWOOJE, RACHAEL ADERONKE
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ADERONKE
Last Name:OWOOJE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10104 SENATE DR STE 222
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4393
Mailing Address - Country:US
Mailing Address - Phone:240-764-5133
Mailing Address - Fax:240-764-8897
Practice Address - Street 1:10104 SENATE DR STE 222
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4393
Practice Address - Country:US
Practice Address - Phone:240-764-5133
Practice Address - Fax:240-764-8897
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBH000416OtherLICENSE