Provider Demographics
NPI:1891131785
Name:DYKES, MICHAEL (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DYKES
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:PO BOX 8472
Mailing Address - Street 2:ATLANTA GA
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31106-0472
Mailing Address - Country:US
Mailing Address - Phone:770-873-1929
Mailing Address - Fax:
Practice Address - Street 1:345 BOULEVARD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1216
Practice Address - Country:US
Practice Address - Phone:770-873-1929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0039981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical