Provider Demographics
NPI:1659147403
Name:OLADIJI, KIKELOMO I
Entity Type:Individual
Prefix:
First Name:KIKELOMO
Middle Name:I
Last Name:OLADIJI
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 1:4609 GREYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-4219
Mailing Address - Country:US
Mailing Address - Phone:682-407-5920
Mailing Address - Fax:
Practice Address - Street 1:4609 GREYBERRY DR
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4219
Practice Address - Country:US
Practice Address - Phone:682-407-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health