Organization
MENTAL WELLNESS PSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOLA FADIPE DNP (PRESIDENT)
(541) 725-2565
Entity
Organization
Contact information
Practice address
188 HUCKLEBERRY LN, FLORENCE, OR 97439-8779
(541) 725-2565
(862) 205-4480
Mailing address
2386 MORRIS AVE STE 205, UNION, NJ 07083-5723
(908) 777-1617
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/27/2025
Last updated
07/03/2025
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