Provider Demographics
NPI:1700293701
Name:ALTIKULAC, NUKTE NICKY F (BCABA)
Entity Type:Individual
Prefix:
First Name:NUKTE NICKY
Middle Name:F
Last Name:ALTIKULAC
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 PEACHTREE PKWY
Mailing Address - Street 2:SUITE#148
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-6536
Mailing Address - Country:US
Mailing Address - Phone:404-394-3382
Mailing Address - Fax:678-302-3453
Practice Address - Street 1:5425 PEACHTREE PKWY
Practice Address - Street 2:SUITE#148
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-6536
Practice Address - Country:US
Practice Address - Phone:404-394-3382
Practice Address - Fax:678-302-3453
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-14-5965103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst