Provider Demographics
NPI:1861524035
Name:KWANELE, BABALWA IFE (LMFT)
Entity type:Individual
Prefix:MS
First Name:BABALWA
Middle Name:IFE
Last Name:KWANELE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3222
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-0222
Mailing Address - Country:US
Mailing Address - Phone:510-355-0351
Mailing Address - Fax:510-355-0351
Practice Address - Street 1:3671 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2009
Practice Address - Country:US
Practice Address - Phone:510-355-0351
Practice Address - Fax:510-355-0351
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12258526OtherCAQH