Provider Demographics
NPI:1770851164
Name:SOUDAN, ADE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ADE
Middle Name:
Last Name:SOUDAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2356 PEACHWOOD CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1802
Mailing Address - Country:US
Mailing Address - Phone:404-213-9273
Mailing Address - Fax:404-751-2836
Practice Address - Street 1:2356 PEACHWOOD CIR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1802
Practice Address - Country:US
Practice Address - Phone:404-213-9273
Practice Address - Fax:404-751-2836
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0027871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical