Organization
MIKALA A LEGAKO PSYD PSYCH SVC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKALA ANNE LEGAKO PSYD (PSYCHOLOGIST/OWNER)
(678) 314-7469
Entity
Organization
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
03/04/2008
Last updated
08/02/2020
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