Provider Demographics
NPI:1053844225
Name:KATIE LEIKAM, LLC
Entity Type:Organization
Organization Name:KATIE LEIKAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIKAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-201-3531
Mailing Address - Street 1:769 SUNNYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4734
Mailing Address - Country:US
Mailing Address - Phone:706-201-3531
Mailing Address - Fax:
Practice Address - Street 1:108 PONCE DE LEON CT
Practice Address - Street 2:SUITE 201
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1960
Practice Address - Country:US
Practice Address - Phone:404-702-1452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0060451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty