Provider Demographics
NPI:1457981763
Name:ASIKARI PERFECT IMPACT, LLC.
Entity Type:Organization
Organization Name:ASIKARI PERFECT IMPACT, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-270-6712
Mailing Address - Street 1:5472 SHIREWICK LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3872
Mailing Address - Country:US
Mailing Address - Phone:678-270-6712
Mailing Address - Fax:
Practice Address - Street 1:235 PEACHTREE ST NE STE 400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1400
Practice Address - Country:US
Practice Address - Phone:678-270-6712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-26
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1992139505Medicaid