Provider Demographics
NPI:1154185304
Name:OLAGBENRO, CHRISTIANA OMOWUMI (LSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIANA
Middle Name:OMOWUMI
Last Name:OLAGBENRO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 GOLDENEYE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-7036
Mailing Address - Country:US
Mailing Address - Phone:614-806-1586
Mailing Address - Fax:
Practice Address - Street 1:1064 GOLDENEYE DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-7036
Practice Address - Country:US
Practice Address - Phone:614-806-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1201568101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health