Provider Demographics
NPI:1821231119
Name:TYEHIMBA, KAMARIA (PHD)
Entity Type:Individual
Prefix:
First Name:KAMARIA
Middle Name:
Last Name:TYEHIMBA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S EDWIN C MOSES BLVD
Mailing Address - Street 2:4TH FLOOR, NW BLDG
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3424
Mailing Address - Country:US
Mailing Address - Phone:937-734-3479
Mailing Address - Fax:937-734-8339
Practice Address - Street 1:601 S EDWIN C MOSES BLVD
Practice Address - Street 2:4TH FLOOR, NW BLDG
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3424
Practice Address - Country:US
Practice Address - Phone:937-734-3479
Practice Address - Fax:937-734-8339
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
OHI.5441104100000X
OH912929104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103T00000XBehavioral Health & Social Service ProvidersPsychologist