Provider Demographics
NPI:1134796527
Name:AFOLAYAN, ABIMBOLA G (PSYD)
Entity type:Individual
Prefix:
First Name:ABIMBOLA
Middle Name:G
Last Name:AFOLAYAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ABIMBOLA
Other - Middle Name:G
Other - Last Name:AFOLAYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:9 WILLEY RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-3119
Mailing Address - Country:US
Mailing Address - Phone:603-817-8439
Mailing Address - Fax:
Practice Address - Street 1:9 WILLEY RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-3119
Practice Address - Country:US
Practice Address - Phone:603-817-8439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-05
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1445103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical