Provider Demographics
NPI:1932473113
Name:IKEGAMI, MAKOTO (DSW, MSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:MAKOTO
Middle Name:
Last Name:IKEGAMI
Suffix:
Gender:M
Credentials:DSW, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 ROSEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-7017
Mailing Address - Country:US
Mailing Address - Phone:470-763-5282
Mailing Address - Fax:
Practice Address - Street 1:1901 ROSEWOOD RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-7017
Practice Address - Country:US
Practice Address - Phone:470-763-5282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0175191041C0700X
FLSW143551041C0700X
GACSW0064471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical