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General NPI Number Information
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NPI Number | 1962836338
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Entity Type | Organization
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Legal Business Name | SOBEK, LLC
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 03/15/2014
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Provider Practice Location Address
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Address Line | 3455 N DESERT DR STE 101
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City | EAST POINT
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State | GA
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Zip | 30344-5725
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Country | US
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Telephone | 678-523-3248
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Fax |
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Provider Business Mailing Address
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Address Line | 8954 LAKE CT
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City | UNION CITY
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State | GA
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Zip | 30291-6031
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Country | US
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Telephone | 678-523-3248
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. AKINKUOTU S. ANGOSISYE
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Credential | LCSW
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Telephone | 678-523-3248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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