Provider Demographics
NPI:1164878401
Name:BANEGAS, SVETLANA (MS MFT)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:BANEGAS
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 WHITLOCK PL SW STE 300
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3155
Mailing Address - Country:US
Mailing Address - Phone:770-316-0813
Mailing Address - Fax:
Practice Address - Street 1:70 WHITLOCK PL SW STE 300
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3155
Practice Address - Country:US
Practice Address - Phone:770-316-0813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001491106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist