Provider Demographics
NPI:1043513419
Name:LUMUMBA, KEHNIDE MUATA (CSAS)
Entity Type:Individual
Prefix:MR
First Name:KEHNIDE
Middle Name:MUATA
Last Name:LUMUMBA
Suffix:
Gender:M
Credentials:CSAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 W VLIET ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2461
Mailing Address - Country:US
Mailing Address - Phone:414-312-8910
Mailing Address - Fax:414-455-3292
Practice Address - Street 1:3020 W VLIET ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-2461
Practice Address - Country:US
Practice Address - Phone:414-312-8910
Practice Address - Fax:414-455-3292
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15253-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)