Provider Demographics
NPI:1699181594
Name:GLICKSTEIN, RICHARD B (LCSW, LISW-CP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:GLICKSTEIN
Suffix:
Gender:M
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:RICH
Other - Middle Name:
Other - Last Name:GLICKSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LISW-CP
Mailing Address - Street 1:1180 GILBERT ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-3102
Mailing Address - Country:US
Mailing Address - Phone:305-613-5552
Mailing Address - Fax:
Practice Address - Street 1:1180 GILBERT ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-3102
Practice Address - Country:US
Practice Address - Phone:305-613-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC0147101YA0400X
GACSW0051761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)