Provider Demographics
NPI:1033237771
Name:ATKINS, DEADRA CARNACK (LCSW-C)
Entity Type:Individual
Prefix:
First Name:DEADRA
Middle Name:CARNACK
Last Name:ATKINS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:DEADRA
Other - Middle Name:CARNACK
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:6936 KNIGHTHOOD LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4801
Mailing Address - Country:US
Mailing Address - Phone:410-381-0559
Mailing Address - Fax:
Practice Address - Street 1:122 LANGLEY RD N
Practice Address - Street 2:SUITE A
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-6539
Practice Address - Country:US
Practice Address - Phone:410-222-6785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD47521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical