Mwangala Kristine Sibetta-Pate, LCSW-LMSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

367 Athens Hwy Ste 1800
Loganville, GA 30052-8293

Phone

(770) 554-2999

Fax

(770) 679-6390

NPI assigned

Jan 18, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1043756885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 ATHENS HWY STE 1800",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300528293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 ATHENS HWY STE 1800",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300528293",
            "telephone_number": "770-554-2999",
            "fax_number": "770-679-6390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2795 Main St W",
            "address_2": "suite 20-b",
            "address_purpose": "LOCATION",
            "city": "Snellville",
            "state": "GA",
            "postal_code": "300783164",
            "country_code": "US",
            "telephone_number": "678-344-7836",
            "fax_number": "678-892-8575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIBETTA-PATE",
        "first_name": "MWANGALA",
        "middle_name": "KRISTINE",
        "credential": "LCSW-LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-18",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Loganville, GA
• Providers in Loganville, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.