Healthcare Provider Details

I. General information

NPI: 1659864130
Provider Name (Legal Business Name): ELZBIETA K SITEK MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 LAWRENCE ST NE
MARIETTA GA
30060-2056
US

IV. Provider business mailing address

321 LAWRENCE ST NE
MARIETTA GA
30060-2056
US

V. Phone/Fax

Practice location:
  • Phone: 678-480-3065
  • Fax:
Mailing address:
  • Phone: 678-480-3065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number010478
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: