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General NPI Number Information
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NPI Number | 1548784721
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Entity Type | Individual
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Provider Name | IMANI Y LUMUMBA CLINICIAN
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Gender | Female
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Dates
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Enumeration Date | 07/31/2017
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Last Update Date | 07/31/2017
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Provider Practice Location Address
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Address Line | 1315 WINDRIM AVENUE 2ND FL. AOP6C
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City | PHILADELPHIA
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State | PA
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Zip | 19144
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Country | US
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Telephone | 215-456-2603
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Fax | 215-754-0318
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Provider Business Mailing Address
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Address Line | 3019 N 21ST ST
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City | PHILADELPHIA
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State | PA
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Zip | 19132-1512
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Country | US
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Telephone | 610-704-5702
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Fax | 215-754-0318
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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