Provider Demographics
NPI:1255900270
Name:KABAMBA, ANTOINETTE (LCDC)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:KABAMBA
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 CENTRE PKWY STE 651
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8478
Mailing Address - Country:US
Mailing Address - Phone:832-576-7671
Mailing Address - Fax:
Practice Address - Street 1:9800 CENTRE PKWY STE 651
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8478
Practice Address - Country:US
Practice Address - Phone:832-576-7671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)