Provider Demographics
NPI:1336705847
Name:OLANIYAN, MODUPE ADEKUNBI (RN, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MODUPE
Middle Name:ADEKUNBI
Last Name:OLANIYAN
Suffix:
Gender:F
Credentials:RN, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10302 HIGHBORO WAY # 222
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2375
Mailing Address - Country:US
Mailing Address - Phone:301-518-7399
Mailing Address - Fax:
Practice Address - Street 1:10302 HIGHBORO WAY # 222
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2375
Practice Address - Country:US
Practice Address - Phone:301-518-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC22125LC7395101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional