Provider Demographics
NPI:1770240228
Name:OLUWALOLA, OLADAYO O (LCSW)
Entity Type:Individual
Prefix:
First Name:OLADAYO
Middle Name:O
Last Name:OLUWALOLA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:OLADAYO
Other - Middle Name:O
Other - Last Name:OGUNLOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:2064 BURSON DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-5304
Mailing Address - Country:US
Mailing Address - Phone:317-529-3370
Mailing Address - Fax:
Practice Address - Street 1:2528 LAS BRISAS DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-4264
Practice Address - Country:US
Practice Address - Phone:757-689-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040133661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty