Provider Demographics
NPI:1447062427
Name:KILANKO, OPEYEMI GLORIA
Entity type:Individual
Prefix:MS
First Name:OPEYEMI GLORIA
Middle Name:
Last Name:KILANKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 SAPPHIRE CT
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-3569
Mailing Address - Country:US
Mailing Address - Phone:404-909-4504
Mailing Address - Fax:
Practice Address - Street 1:2363 SAPPHIRE CT
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-3569
Practice Address - Country:US
Practice Address - Phone:404-909-4504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health