Provider Demographics
NPI:1336745363
Name:KUKOYI-ADEWUSI, AFISAT (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AFISAT
Middle Name:
Last Name:KUKOYI-ADEWUSI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 JODY KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2975
Mailing Address - Country:US
Mailing Address - Phone:410-961-8331
Mailing Address - Fax:
Practice Address - Street 1:7912 JODY KNOLL RD
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2975
Practice Address - Country:US
Practice Address - Phone:410-961-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18793104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker