Provider Demographics
NPI:1174108997
Name:NASH LIGHTSEY, JANIKA DANAE
Entity type:Individual
Prefix:MS
First Name:JANIKA
Middle Name:DANAE
Last Name:NASH LIGHTSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 N. BERKELEY LAKE RD.
Mailing Address - Street 2:1317
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:678-368-9310
Mailing Address - Fax:
Practice Address - Street 1:2620 N BERKELEY LAKE RD NW APT 1317
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1444
Practice Address - Country:US
Practice Address - Phone:678-368-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009699104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker