Provider Demographics
NPI:1235751801
Name:BOYD, MALIKA A (LCSW)
Entity Type:Individual
Prefix:
First Name:MALIKA
Middle Name:A
Last Name:BOYD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 SUMMERWALK PKWY
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8435
Mailing Address - Country:US
Mailing Address - Phone:470-588-0716
Mailing Address - Fax:
Practice Address - Street 1:2302 SUMMERWALK PKWY
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8435
Practice Address - Country:US
Practice Address - Phone:470-588-0716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-17
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0060601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW006060OtherGEORGIA COMPOSITE BOARD