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Organization
KOLA GROUP
Active
Organization
KOLA GROUP
Active
Other names
MODEST BEHAVIORAL HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
TAJUDEEN ADEBAYO KOLAWOLE (CRNP)
(610) 563-3767
Entity
Organization
Contact information
Practice address
5438 N LAWRENCE ST, PHILADELPHIA, PA 19120-2804
(610) 563-3767
Mailing address
819 SELMA ST, PHILADELPHIA, PA 19116-2923
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/03/2023
Last updated
07/03/2023
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