Provider Demographics
NPI:1043081623
Name:SIKOD, STELLA NAGWA
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:NAGWA
Last Name:SIKOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4590 SAGEBRUSH CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-2507
Mailing Address - Country:US
Mailing Address - Phone:678-499-2411
Mailing Address - Fax:
Practice Address - Street 1:4590 SAGEBRUSH CT
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-2507
Practice Address - Country:US
Practice Address - Phone:678-499-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23-318933103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst