Provider Demographics
NPI:1558196519
Name:TOTOOLA, AYODEJI SAMUEL
Entity type:Individual
Prefix:
First Name:AYODEJI
Middle Name:SAMUEL
Last Name:TOTOOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 W ELM ST APT 401
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4345
Mailing Address - Country:US
Mailing Address - Phone:857-505-5773
Mailing Address - Fax:
Practice Address - Street 1:47 W ELM ST APT 401
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4345
Practice Address - Country:US
Practice Address - Phone:857-505-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor