Healthcare Provider Details

I. General information

NPI: 1528331055
Provider Name (Legal Business Name): KITWANA TYHIMBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 GROVE ST
SAN FRANCISCO CA
94117-1008
US

IV. Provider business mailing address

2157 GROVE ST
SAN FRANCISCO CA
94117-1008
US

V. Phone/Fax

Practice location:
  • Phone: 415-387-2275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: