Basic Information
| Provider Information | |||||||||
| NPI: | 1922668508 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AKINWANDE | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | ADEMOLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 372 ST MONTELENA CT | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936373805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239738930 | ||||||||
| FaxNumber: | 5308945791 | ||||||||
| Practice Location | |||||||||
| Address1: | 4324 W HARVARD AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937225183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596811470 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2019 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 103366 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.