Healthcare Provider Details

I. General information

NPI: 1962376095
Provider Name (Legal Business Name): NIKITA LASHAE BURKE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 EXECUTIVE PARK DR NE FL 5
ATLANTA GA
30329-2206
US

IV. Provider business mailing address

12 EXECUTIVE PARK DR NE FL 5
ATLANTA GA
30329-2206
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3444
  • Fax:
Mailing address:
  • Phone: 404-778-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW008622
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: