Provider Demographics
NPI:1043756885
Name:SIBETTA-PATE, MWANGALA KRISTINE (LCSW-LMSW)
Entity Type:Individual
Prefix:
First Name:MWANGALA
Middle Name:KRISTINE
Last Name:SIBETTA-PATE
Suffix:
Gender:F
Credentials:LCSW-LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 ATHENS HWY STE 1800
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:367 ATHENS HWY STE 1800
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8293
Practice Address - Country:US
Practice Address - Phone:770-554-2999
Practice Address - Fax:770-679-6390
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health