Provider Demographics
NPI:1881053957
Name:MCCOY, RIKKI CLARK (LCSW)
Entity type:Individual
Prefix:
First Name:RIKKI
Middle Name:CLARK
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 BUFORD HWY NE
Mailing Address - Street 2:700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3207
Mailing Address - Country:US
Mailing Address - Phone:678-322-7935
Mailing Address - Fax:678-922-2149
Practice Address - Street 1:2751 BUFORD HWY NE
Practice Address - Street 2:700
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3207
Practice Address - Country:US
Practice Address - Phone:678-322-7935
Practice Address - Fax:678-922-2149
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0057081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical