Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | MD | |
N | 101YM0800X | Mental Health Counselor | MD | |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 408449700, 409426300 | MD |
N | 103TR0400X | Rehabilitation Psychologist | MD |
NPI | 1669405270 |
---|---|
Provider Name | Mr. Isaac Abioye Olasupo |
First Address | New Carrollton, MD 20784-3636 |
Second Address | Baltimore, MD 21218-5758 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 09/07/2007 |