Provider Demographics
NPI:1306899976
Name:NGUMBA-GATABAKI, EUNICE WANJIRU (PHD)
Entity type:Individual
Prefix:MS
First Name:EUNICE
Middle Name:WANJIRU
Last Name:NGUMBA-GATABAKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 GREENVILLE LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587
Mailing Address - Country:US
Mailing Address - Phone:919-274-0596
Mailing Address - Fax:919-373-1595
Practice Address - Street 1:839 DURHAM RD STE C
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8793
Practice Address - Country:US
Practice Address - Phone:919-274-0596
Practice Address - Fax:919-928-5160
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2386103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000770Medicaid