Provider Demographics
NPI:1366933897
Name:PULICKEN, ABILASH P
Entity type:Individual
Prefix:
First Name:ABILASH
Middle Name:P
Last Name:PULICKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5686 FULTON INDUSTRIAL BLVD SW
Mailing Address - Street 2:UNIT 44528
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30336
Mailing Address - Country:US
Mailing Address - Phone:404-914-4782
Mailing Address - Fax:404-914-4782
Practice Address - Street 1:2001 MARTIN LUTHER KING JR DR SW STE 540
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1101
Practice Address - Country:US
Practice Address - Phone:404-914-4782
Practice Address - Fax:404-914-4782
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health