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General NPI Number Information
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NPI Number | 1841655578
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Entity Type | Individual
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Provider Name | NJIL KABAMBA I
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Gender | Male
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Dates
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Enumeration Date | 12/23/2015
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 6000 BASS LAKE RD STE 206
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City | CRYSTAL
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State | MN
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Zip | 55429-2766
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Country | US
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Telephone | 763-746-0396
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Fax |
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Provider Business Mailing Address
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Address Line | 5649 ZEALAND AVE N
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City | NEW HOPE
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State | MN
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Zip | 55428-5334
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Country | US
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Telephone | 612-245-3346
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | PCA49064420151014
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License Number State | MN
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