Provider Demographics
NPI:1427664150
Name:KAYUMBA, MADIMBA
Entity type:Individual
Prefix:
First Name:MADIMBA
Middle Name:
Last Name:KAYUMBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 ARLINGTON DR APT 204
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3626
Mailing Address - Country:US
Mailing Address - Phone:716-279-9379
Mailing Address - Fax:
Practice Address - Street 1:505 WINDY KNOLL DR UNIT 323
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-6614
Practice Address - Country:US
Practice Address - Phone:240-668-4415
Practice Address - Fax:240-673-6322
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA850103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty