Provider Demographics
NPI:1902388861
Name:HOWARD, OLATUNDE D (LMFTA)
Entity Type:Individual
Prefix:
First Name:OLATUNDE
Middle Name:D
Last Name:HOWARD
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 SELWYN LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5310
Mailing Address - Country:US
Mailing Address - Phone:810-241-4123
Mailing Address - Fax:
Practice Address - Street 1:2000 YONKERS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2258
Practice Address - Country:US
Practice Address - Phone:919-551-3935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12109A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist