Individual
IFEDOLA 0 OLOWE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HS-BCP 2303
Contact information
Practice address
442 BEACH 46TH ST, FAR ROCKAWAY, NY 11691-1114
(917) 971-1074
Mailing address
442 BEACH 46TH ST, FAR ROCKAWAY, NY 11691-1114
(917) 971-1074
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2303
NC
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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