Provider Demographics
NPI:1679188072
Name:HELEN KUMOLALO
Entity Type:Organization
Organization Name:HELEN KUMOLALO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMOLALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-631-4318
Mailing Address - Street 1:5205 EAST DR STE H
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5205 EAST DR STE H
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-2403
Practice Address - Country:US
Practice Address - Phone:410-242-0423
Practice Address - Fax:410-242-0459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GILGAL GROUP PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)