Provider Demographics
NPI:1922619907
Name:MBUMINA, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MBUMINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 RAINTREE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8920
Mailing Address - Country:US
Mailing Address - Phone:704-710-6272
Mailing Address - Fax:
Practice Address - Street 1:8001 RAINTREE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8920
Practice Address - Country:US
Practice Address - Phone:704-710-6272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15928101YM0800X
NC15928101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1407335953Medicaid