Provider Demographics
NPI:1053450148
Name:ATKINS, LISA ANNE (LCSW LCAS)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANNE
Last Name:ATKINS
Suffix:
Gender:F
Credentials:LCSW LCAS
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:ANNE MCBRIDE
Other - Last Name:ATKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2091 US 220 ALT N
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:NC
Mailing Address - Zip Code:27356
Mailing Address - Country:US
Mailing Address - Phone:910-576-1188
Mailing Address - Fax:910-576-1182
Practice Address - Street 1:318 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371
Practice Address - Country:US
Practice Address - Phone:910-576-1188
Practice Address - Fax:910-576-1182
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC970101Y00000X
NCC005495104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111844Medicaid