Provider Demographics
NPI:1063254001
Name:FAWEHINMI, OLAYINKA SAMUEL (MSCM)
Entity type:Individual
Prefix:
First Name:OLAYINKA
Middle Name:SAMUEL
Last Name:FAWEHINMI
Suffix:
Gender:M
Credentials:MSCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4452
Mailing Address - Country:US
Mailing Address - Phone:405-509-1011
Mailing Address - Fax:
Practice Address - Street 1:188 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4452
Practice Address - Country:US
Practice Address - Phone:405-509-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor