Provider Demographics
NPI:1215635867
Name:FASAWE, ABIMBOLA OLUFUNKE
Entity type:Individual
Prefix:
First Name:ABIMBOLA
Middle Name:OLUFUNKE
Last Name:FASAWE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 S CRYSTAL WAY APT 103
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3650
Mailing Address - Country:US
Mailing Address - Phone:973-932-4114
Mailing Address - Fax:
Practice Address - Street 1:6385 CORPORATE DR STE 200-41
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-5901
Practice Address - Country:US
Practice Address - Phone:719-341-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician