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General NPI Number Information
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NPI Number | 1659995330
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Entity Type | Organization
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Legal Business Name | DEAF ACCESS TO QUALITY LIFE
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 1901 ROSEWOOD RD
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City | DECATUR
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State | GA
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Zip | 30032-7017
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Country | US
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Telephone | 215-987-2730
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 ROSEWOOD RD
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City | DECATUR
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State | GA
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Zip | 30032-7017
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Country | US
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Telephone | 215-987-2730
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. MAKOTO IKEGAMI I
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Credential | DSW, LCSW, MSW
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Telephone | 215-987-2730
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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 |
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License Number State |
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