Provider Demographics
NPI:1013368034
Name:KIAMBA, KATUNGWA
Entity Type:Individual
Prefix:MS
First Name:KATUNGWA
Middle Name:
Last Name:KIAMBA
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:PO BOX 971961
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-0235
Mailing Address - Country:US
Mailing Address - Phone:734-635-7004
Mailing Address - Fax:734-219-7197
Practice Address - Street 1:1431 ROOSEVELT
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2034
Practice Address - Country:US
Practice Address - Phone:734-635-7004
Practice Address - Fax:734-219-7197
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801033763104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker