Individual provider · Type 1 NPI

Kowanda Tenkapowom

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Augusta, GA

NPI number 1316212749 Active

Practice location

3421 Mike Padgett Hwy
Augusta, GA 30906-3815

Call (706) 432-7893 Map

Fax (706) 432-3780

Mailing address

3347 Ravenwood Dr
Augusta, GA 30907-3574

Specialties and licenses

TaxonomyCodeLicense
Intellectual & Developmental Disabilities Psychologist 103TM1800XNone listed
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary 320900000XNone listed

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

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About NPI 1316212749

Kowanda Tenkapowom's National Provider Identifier is 1316212749, issued on Mar 19, 2012. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Augusta, GA. The record was last updated on Mar 19, 2012.