Provider Demographics
NPI:1255864161
Name:AIKEN, ANTWAN GILBERT (LCSW, MPA)
Entity Type:Individual
Prefix:
First Name:ANTWAN
Middle Name:GILBERT
Last Name:AIKEN
Suffix:
Gender:M
Credentials:LCSW, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 REUNION PL SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-6350
Mailing Address - Country:US
Mailing Address - Phone:404-964-6147
Mailing Address - Fax:
Practice Address - Street 1:1045 REUNION PL SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-6350
Practice Address - Country:US
Practice Address - Phone:404-964-6147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical