Basic Information
| Provider Information | |||||||||
| NPI: | 1629516596 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHODEINDE | ||||||||
| FirstName: | OLUDAMILOLA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5514 AXTON CT | ||||||||
| Address2: | |||||||||
| City: | LANHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207062050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012735202 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9701 PHILADELPHIA CT | ||||||||
| Address2: | |||||||||
| City: | LANHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207064400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014773339 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2017 | ||||||||
| LastUpdateDate: | 12/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/10/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LC50080631 | DC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 16405 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.