Provider Demographics
NPI:1275868556
Name:ATLAS SUPPORTS
Entity Type:Organization
Organization Name:ATLAS SUPPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:ATLAS
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-582-9003
Mailing Address - Street 1:113 SALUDA SHORES CIR
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-7235
Mailing Address - Country:US
Mailing Address - Phone:803-582-9003
Mailing Address - Fax:803-234-2927
Practice Address - Street 1:113 SALUDA SHORES CIR
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-7235
Practice Address - Country:US
Practice Address - Phone:803-582-9003
Practice Address - Fax:803-234-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-05-2205103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCWP8953Medicaid