Provider Demographics
NPI:1699230052
Name:BANJOKO, JOSEPHINE LOLA
Entity Type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:LOLA
Last Name:BANJOKO
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 1:1402 PARK HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3878
Mailing Address - Country:US
Mailing Address - Phone:404-245-9726
Mailing Address - Fax:
Practice Address - Street 1:1402 PARK HOLLOW LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-3878
Practice Address - Country:US
Practice Address - Phone:404-245-9726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral