Provider Demographics
NPI:1306597893
Name:ZIBANAYI, NOMPILO LOICE
Entity type:Individual
Prefix:MRS
First Name:NOMPILO
Middle Name:LOICE
Last Name:ZIBANAYI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NOMPILO
Other - Middle Name:LOICE
Other - Last Name:SHAVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:851 S STATE ROAD 434 STE 1070-206
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-4811
Mailing Address - Country:US
Mailing Address - Phone:407-620-6434
Mailing Address - Fax:
Practice Address - Street 1:6505 216TH ST SW STE 100
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2089
Practice Address - Country:US
Practice Address - Phone:407-657-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-16
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
WASWIA.SC.613979521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical