Doctor Name: | MR. PANANKOSI MBUNJWA |
NPI Number: | 1174949796 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LLMSW |
License Number: | 6801096352 |
Business Practice Address: | 1485 S M-139 Benton Harbor, MI - 49022 |
Business Phone Number: | 2699250585 |
Business Fax Number: | 2699271326 |
Mailing Address: | 1485 S M-139, BENTON HARBOR |
State: | MI |
Postal Code: | 49022 |
Phone Number: | 2699250585 |
Fax Number: | 2699271326 |
NPI Enumeration Date: | 03/06/2014 |
NPI Last Update Date: | 03/06/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801096352 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |