Individual
INNOCENT IKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2001 MARTIN LUTHER KING JR DR SW, SUITE, ATLANTA, GA 30310-1101
(404) 564-6486
(404) 564-6487
Mailing address
2001 MARTIN LUTHER KING JR DR SW, SUITE, ATLANTA, GA 30310-1101
(404) 564-6486
(404) 564-6487
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
171W00000X
Contractor
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
11/26/2014
Last updated
11/26/2014
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