Provider Demographics
NPI:1063209468
Name:OGUNRO, ABOSEDE (LCSWA)
Entity type:Individual
Prefix:
First Name:ABOSEDE
Middle Name:
Last Name:OGUNRO
Suffix:
Gender:
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5921 GRABURNS FORD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7121
Mailing Address - Country:US
Mailing Address - Phone:704-576-3918
Mailing Address - Fax:
Practice Address - Street 1:5921 GRABURNS FORD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7121
Practice Address - Country:US
Practice Address - Phone:704-576-3918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NCP020127251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health