Provider Demographics
NPI:1194419077
Name:OGUNDIYUN, MAYOWA (LCPC)
Entity type:Individual
Prefix:MS
First Name:MAYOWA
Middle Name:
Last Name:OGUNDIYUN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8011 MANDAN RD APT 104
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2864
Mailing Address - Country:US
Mailing Address - Phone:240-505-2788
Mailing Address - Fax:
Practice Address - Street 1:8011 MANDAN RD APT 104
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2864
Practice Address - Country:US
Practice Address - Phone:240-505-2788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0744103T00000X
MDLC11848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty