Individual
BOLADALE WURAOLA ADEGOROYE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
768 DUVALL HWY, PASADENA, MD 21122-1620
(240) 481-9962
Mailing address
PO BOX 444, PASADENA, MD 21123-0444
(240) 481-9962
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LC7193
MD
101YM0800X
Mental Health Counselor
LC7193
MD
101YP2500X
Professional Counselor
Primary
LC7193
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1155938 00
—
MD
Enumeration date
01/16/2015
Last updated
02/23/2017
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