Provider Demographics
NPI:1013882695
Name:SIVELS, SHANITA (LMSW)
Entity type:Individual
Prefix:MS
First Name:SHANITA
Middle Name:
Last Name:SIVELS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHANITA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:629 WAYLAND CT
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-6535
Mailing Address - Country:US
Mailing Address - Phone:773-668-3367
Mailing Address - Fax:
Practice Address - Street 1:629 WAYLAND CT
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-6535
Practice Address - Country:US
Practice Address - Phone:773-668-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14112104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker