Individual
ADEMOLA CLEMENT OMISAKIN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LGPC
Contact information
Practice address
5900 PRINCESS GARDEN PKWY, LANHAM, MD 20706-2925
(301) 851-5954
Mailing address
10900 WHARTON DR, UPPER MARLBORO, MD 20774-1469
(240) 544-8610
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LGP10524
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84-2094162
—
MD
Enumeration date
07/01/2020
Last updated
07/01/2020
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