Provider Demographics
NPI:1003126418
Name:KIHATO, S. NYAMBURA (MA, MED, LPC)
Entity Type:Individual
Prefix:
First Name:S.
Middle Name:NYAMBURA
Last Name:KIHATO
Suffix:
Gender:F
Credentials:MA, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3461
Mailing Address - Country:US
Mailing Address - Phone:470-736-9595
Mailing Address - Fax:
Practice Address - Street 1:3160 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3461
Practice Address - Country:US
Practice Address - Phone:470-736-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002607101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional