Individual
DR. MIKALA ANNE LEGAKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
83 BAILEY DR, NEWNAN, GA 30263-2913
(678) 314-7469
Mailing address
83 BAILEY DR, NEWNAN, GA 30263-2913
(678) 314-7469
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
002428
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000895617B
—
GA
01
—
002428
PSYCHOLOGY LICENSE
GA
Enumeration date
04/04/2007
Last updated
08/02/2020
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