Provider Demographics
NPI:1205561313
Name:LIGON, JAN H (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:H
Last Name:LIGON
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 PIEDMONT AVE NE UNIT 3120
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1494
Mailing Address - Country:US
Mailing Address - Phone:770-316-5417
Mailing Address - Fax:
Practice Address - Street 1:850 PIEDMONT AVE NE UNIT 3120
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1494
Practice Address - Country:US
Practice Address - Phone:770-316-5417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0017371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical