Provider Demographics
NPI:1376242453
Name:TENDE, KIWANYA (RSPS, LCDCI)
Entity Type:Individual
Prefix:
First Name:KIWANYA
Middle Name:
Last Name:TENDE
Suffix:
Gender:F
Credentials:RSPS, LCDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-8023
Mailing Address - Country:US
Mailing Address - Phone:832-290-9356
Mailing Address - Fax:
Practice Address - Street 1:2103 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-8023
Practice Address - Country:US
Practice Address - Phone:322-909-3568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61725101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX46-3260734OtherRECOVERY SUPPORT SERVICES