Provider Demographics
NPI:1265185425
Name:LEEK, KRYSTALL JEANETTE (LMSW)
Entity type:Individual
Prefix:
First Name:KRYSTALL
Middle Name:JEANETTE
Last Name:LEEK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 BLACKMON DR APT 5206
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6238
Mailing Address - Country:US
Mailing Address - Phone:859-200-7891
Mailing Address - Fax:
Practice Address - Street 1:256 MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2337
Practice Address - Country:US
Practice Address - Phone:770-450-6120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW010381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker