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General NPI Number Information
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NPI Number | 1295949766
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Entity Type | Individual
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Provider Name | KHALFANI MWAMBA CDP
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 400 YESLER WAY #110
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City | SEATTLE
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State | WA
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Zip | 98104-2683
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Country | US
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Telephone | 206-302-2200
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Fax | 306-302-2210
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Provider Business Mailing Address
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Address Line | 1600 E. OLIVE ST. SOUND MENTAL HEALTH
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City | SEATTLE
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State | WA
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Zip | 98118-4425
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Country | US
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Telephone | 206-302-2200
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Fax | 206-302-2210
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP00005174
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License Number State | WA
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