Provider Demographics
NPI:1780402610
Name:ALUKO, IJENNA NICOLA
Entity type:Individual
Prefix:MRS
First Name:IJENNA
Middle Name:NICOLA
Last Name:ALUKO
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 1:16208 ALSON WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1513
Mailing Address - Country:US
Mailing Address - Phone:240-838-2540
Mailing Address - Fax:
Practice Address - Street 1:16208 ALSON WAY
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1513
Practice Address - Country:US
Practice Address - Phone:240-838-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9496101YM0800X, 101YP2500X, 103TB0200X, 103TM1800X, 106H00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist