Provider Demographics
NPI:1447092473
Name:AKINNUSI, FOLA PIUS
Entity type:Individual
Prefix:
First Name:FOLA
Middle Name:PIUS
Last Name:AKINNUSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 33RD AVE S APT 105
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6571
Mailing Address - Country:US
Mailing Address - Phone:302-250-6189
Mailing Address - Fax:
Practice Address - Street 1:2201 33RD AVE S APT 105
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6571
Practice Address - Country:US
Practice Address - Phone:302-250-6189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)