Provider Demographics
NPI:1568612554
Name:AMOLA, OLUWAKEMI IYABO (PHD, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:OLUWAKEMI
Middle Name:IYABO
Last Name:AMOLA
Suffix:
Gender:F
Credentials:PHD, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8612 NEUSE STONE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-7886
Mailing Address - Country:US
Mailing Address - Phone:919-452-1577
Mailing Address - Fax:
Practice Address - Street 1:1073 BULLARD CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6867
Practice Address - Country:US
Practice Address - Phone:888-557-4080
Practice Address - Fax:919-249-2150
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7110251S00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251S00000XAgenciesCommunity/Behavioral Health