Provider Demographics
NPI:1285140467
Name:OLAWALE, OMOWUMI OLUMAYOWA (CCM)
Entity type:Individual
Prefix:MRS
First Name:OMOWUMI
Middle Name:OLUMAYOWA
Last Name:OLAWALE
Suffix:
Gender:F
Credentials:CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 TYLNEY HALL CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-3039
Mailing Address - Country:US
Mailing Address - Phone:410-718-6700
Mailing Address - Fax:
Practice Address - Street 1:3507 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2203
Practice Address - Country:US
Practice Address - Phone:410-718-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-24
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4208759171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty