Individual
GEORGE OLORUNFEMI ADEOLA OLUSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CHAPLAIN/PASTOR
Contact information
Practice address
5651 S MESQUITE GROVE WAY, CHANDLER, AZ 85249-9670
(480) 240-0412
Mailing address
PO BOX 12301, CHANDLER, AZ 85248-0022
(480) 240-0412
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
D04019037
AZ
101YP1600X
Pastoral Counselor
Primary
D04019037
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D04019037
AZ STATE MVD
AZ
Enumeration date
10/17/2020
Last updated
10/17/2020
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