Provider Demographics
NPI:1336880855
Name:NIKI GORI, LPC, LLC
Entity Type:Organization
Organization Name:NIKI GORI, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-909-1046
Mailing Address - Street 1:1640 POWERS FERRY RD SE BLDG 8-150
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-1476
Mailing Address - Country:US
Mailing Address - Phone:404-487-8535
Mailing Address - Fax:
Practice Address - Street 1:1640 POWERS FERRY RD SE BLDG 8-150
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-1476
Practice Address - Country:US
Practice Address - Phone:404-487-8535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty