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General NPI Number Information
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NPI Number | 1447354980
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Entity Type | Organization
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Legal Business Name | DALLAS VA MEDICAL CENTER
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4500 S LANCASTER RD
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City | DALLAS
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State | TX
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Zip | 75216-7167
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Country | US
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Telephone | 323-327-7618
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 S LANCASTER RD
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City | DALLAS
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State | TX
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Zip | 75216-7167
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Country | US
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Telephone | 323-327-7618
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Fax |
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Authorized Official
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Title or Position | ADDICTION THERAPIST
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Name | MR. KABAKA WAMUKUTA POKOSSA
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Credential | MASTERS OF SCINECE
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Telephone | 214-857-0837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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