Provider Demographics
NPI:1043929896
Name:ATKINSON, RICHARD O'NEALE IV (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:O'NEALE
Last Name:ATKINSON
Suffix:IV
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12827 MOSBY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4842
Mailing Address - Country:US
Mailing Address - Phone:803-519-7407
Mailing Address - Fax:
Practice Address - Street 1:5007 PROVIDENCE RD STE 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5907
Practice Address - Country:US
Practice Address - Phone:704-364-6594
Practice Address - Fax:704-364-6596
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0154401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical