Provider Demographics
NPI:1962158154
Name:AYOOLA, TOLULOPE (LCSWA)
Entity type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:
Last Name:AYOOLA
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6926
Mailing Address - Country:US
Mailing Address - Phone:704-699-9772
Mailing Address - Fax:
Practice Address - Street 1:2304 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6926
Practice Address - Country:US
Practice Address - Phone:704-699-9772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO154351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical