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General NPI Number Information
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NPI Number | 1053844225
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Entity Type | Organization
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Legal Business Name | KATIE LEIKAM, LLC
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 108 PONCE DE LEON CT SUITE 201
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City | DECATUR
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State | GA
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Zip | 30030-1960
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Country | US
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Telephone | 404-702-1452
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Fax |
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Provider Business Mailing Address
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Address Line | 769 SUNNYBROOK DR
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City | DECATUR
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State | GA
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Zip | 30033-4734
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Country | US
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Telephone | 706-201-3531
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATIE LEIKAM
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Credential |
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Telephone | 706-201-3531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW006045
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License Number State | GA
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