Provider Demographics
NPI:1295949766
Name:MWAMBA, KHALFANI (CDP)
Entity type:Individual
Prefix:MR
First Name:KHALFANI
Middle Name:
Last Name:MWAMBA
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E. OLIVE ST.
Mailing Address - Street 2:SOUND MENTAL HEALTH
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-4425
Mailing Address - Country:US
Mailing Address - Phone:206-302-2200
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:400 YESLER WAY
Practice Address - Street 2:#110
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2683
Practice Address - Country:US
Practice Address - Phone:206-302-2200
Practice Address - Fax:306-302-2210
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005174101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)