Provider Demographics
NPI:1700805165
Name:SITHOLE, SIPHIKELELO (LCSW)
Entity Type:Individual
Prefix:
First Name:SIPHIKELELO
Middle Name:
Last Name:SITHOLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 SUMMIT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-6946
Mailing Address - Country:US
Mailing Address - Phone:770-469-0978
Mailing Address - Fax:
Practice Address - Street 1:CLIFTON SPRINGS MENTAL HEALTH CENTER
Practice Address - Street 2:3110 CLIFTON SPRINGS RD
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034
Practice Address - Country:US
Practice Address - Phone:404-243-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0034791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical