Provider Demographics
NPI:1164226890
Name:ABIMBOLA, MARIAM OLAYINKA
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:OLAYINKA
Last Name:ABIMBOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIAM
Other - Middle Name:OLAYINKA
Other - Last Name:ABDULSALAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAIDEN
Mailing Address - Street 1:11703 S LAUREL DR APT 1012
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2981
Mailing Address - Country:US
Mailing Address - Phone:240-413-9636
Mailing Address - Fax:
Practice Address - Street 1:6911 LAUREL BOWIE RD STE 309
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1712
Practice Address - Country:US
Practice Address - Phone:301-755-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician