Provider Demographics
NPI:1710351317
Name:KAPALAMULA, MTISUNGE ERICA
Entity Type:Individual
Prefix:
First Name:MTISUNGE
Middle Name:ERICA
Last Name:KAPALAMULA
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 1:2630 PRAIRIE AVE
Mailing Address - Street 2:APT C201
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-4270
Mailing Address - Country:US
Mailing Address - Phone:574-383-4135
Mailing Address - Fax:
Practice Address - Street 1:424 PERRY ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3200
Practice Address - Country:US
Practice Address - Phone:219-809-0333
Practice Address - Fax:219-809-0334
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health