Provider Demographics
NPI:1679863534
Name:ZAWAIRA, TENDAI NICOLE (LADC)
Entity Type:Individual
Prefix:MS
First Name:TENDAI
Middle Name:NICOLE
Last Name:ZAWAIRA
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MAIN ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3271
Mailing Address - Country:US
Mailing Address - Phone:612-326-7556
Mailing Address - Fax:
Practice Address - Street 1:3329 UNIVERSITY AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3325
Practice Address - Country:US
Practice Address - Phone:612-454-2260
Practice Address - Fax:612-454-2340
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302929101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)