Provider Demographics
NPI:1982819850
Name:AYINDE, BOLANLE (MSW, LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:BOLANLE
Middle Name:
Last Name:AYINDE
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1233
Mailing Address - Country:US
Mailing Address - Phone:301-779-0988
Mailing Address - Fax:
Practice Address - Street 1:4918 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1233
Practice Address - Country:US
Practice Address - Phone:301-779-0988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC50077739101YM0800X
MD124701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4068220 00.Medicaid