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Kowanda Tenkapowom
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Augusta, Georgia
NPI 1316212749

Kowanda Tenkapowom is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Augusta, GA. Kowanda Tenkapowom practices in Augusta, GA. The NPI Number for Kowanda Tenkapowom is 1316212749 and holds a License No. (Georgia).

The current practice location address for Kowanda Tenkapowom is 3421 Mike Padgett Hwy, Augusta, GA and can be reached out via phone at 706-432-7893 and via fax at 706-432-3780.

Location: 3421 Mike Padgett Hwy, Augusta, GA, 30907-3574
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1316212749
Provider Name
Kowanda Tenkapowom
Credential
Provider Entity Type
Individual
Gender
Female
Address
3421 Mike Padgett Hwy, Augusta, GA, 30907-3574
Phone Number
706-432-7893
Fax Number
706-432-3780
Provider Enumeration Date
03/19/2012
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
000606317B 05 GA
institution
Provider Business Practice Location Address Details
Address
3421 Mike Padgett Hwy
City
Augusta
State
Georgia
Zip
30906-3815
Phone Number
706-432-7893
Fax Number
706-432-3780
person
Provider Business Mailing Address Details
Address
3421 Mike Padgett Hwy
City
Augusta
State
Georgia
Zip
30906-3815
Phone Number
706-432-7893
Fax Number
706-432-3780
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Psychologist
Speciality
Intellectual & Developmental Disabilities
Taxonomy
103TM1800X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
()
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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