Provider Demographics
NPI:1447354980
Name:DALLAS VA MEDICAL CENTER
Entity type:Organization
Organization Name:DALLAS VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADDICTION THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KABAKA
Authorized Official - Middle Name:WAMUKUTA
Authorized Official - Last Name:POKOSSA
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS OF SCINECE
Authorized Official - Phone:214-857-0837
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:323-327-7618
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:323-327-7618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty