Provider Demographics
NPI:1962836338
Name:SOBEK, LLC
Entity Type:Organization
Organization Name:SOBEK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AKINKUOTU
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANGOSISYE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-523-3248
Mailing Address - Street 1:8954 LAKE CT
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-6031
Mailing Address - Country:US
Mailing Address - Phone:678-523-3248
Mailing Address - Fax:
Practice Address - Street 1:3455 N DESERT DR STE 101
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5725
Practice Address - Country:US
Practice Address - Phone:678-523-3248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health