1053450148 NPI number — MRS. LISA ANNE ATKINS LCSW LCAS

Table of content: MRS. LISA ANNE ATKINS LCSW LCAS (NPI 1053450148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053450148 NPI number — MRS. LISA ANNE ATKINS LCSW LCAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATKINS
Provider First Name:
LISA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW LCAS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ATKINS
Provider Other First Name:
LISA
Provider Other Middle Name:
ANNE MCBRIDE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1053450148
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2091 US 220 ALT N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAR
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-576-1188
Provider Business Mailing Address Fax Number:
910-576-1182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-576-1188
Provider Business Practice Location Address Fax Number:
910-576-1182
Provider Enumeration Date:
02/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  970 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 104100000X , with the licence number: C005495 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6111844 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".