Provider Demographics
NPI:1407604853
Name:KEHINDE, OLAMIDE (QMHP)
Entity type:Individual
Prefix:
First Name:OLAMIDE
Middle Name:
Last Name:KEHINDE
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CRESTLINE DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1470
Mailing Address - Country:US
Mailing Address - Phone:434-851-8657
Mailing Address - Fax:434-849-7083
Practice Address - Street 1:2250 MURRELL RD STE B1&2
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2141
Practice Address - Country:US
Practice Address - Phone:434-849-7083
Practice Address - Fax:434-849-7665
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty