Provider Demographics
NPI:1841655578
Name:KABAMBA, NJIL I
Entity type:Individual
Prefix:
First Name:NJIL
Middle Name:
Last Name:KABAMBA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5649 ZEALAND AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-5334
Mailing Address - Country:US
Mailing Address - Phone:612-245-3346
Mailing Address - Fax:
Practice Address - Street 1:6000 BASS LAKE RD STE 206
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-2766
Practice Address - Country:US
Practice Address - Phone:763-746-0396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNPCA49064420151014101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor