Provider Demographics
NPI:1295248219
Name:ADEYALE, DAMILOLA
Entity type:Individual
Prefix:
First Name:DAMILOLA
Middle Name:
Last Name:ADEYALE
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 1:7710 HEARTHSIDE WAY UNIT 216
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7605
Mailing Address - Country:US
Mailing Address - Phone:240-688-3233
Mailing Address - Fax:
Practice Address - Street 1:7710 HEARTHSIDE WAY UNIT 216
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-7605
Practice Address - Country:US
Practice Address - Phone:240-688-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst