Provider Demographics
NPI:1588796825
Name:BALKISSOON, INDIRA PADMINI (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:INDIRA
Middle Name:PADMINI
Last Name:BALKISSOON
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 1:6006 EAGLE TIFF LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7103
Mailing Address - Country:US
Mailing Address - Phone:678-447-4040
Mailing Address - Fax:
Practice Address - Street 1:3110 CLIFTON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4600
Practice Address - Country:US
Practice Address - Phone:404-243-9500
Practice Address - Fax:404-244-2224
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036801041C0700X
TX348261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical