Provider Demographics
NPI:1376231969
Name:ATKINS, GLENDA RENEE (PHD)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:RENEE
Last Name:ATKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 DALLRIVA DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-6180
Mailing Address - Country:US
Mailing Address - Phone:662-347-3110
Mailing Address - Fax:
Practice Address - Street 1:841 DALLRIVA DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-6180
Practice Address - Country:US
Practice Address - Phone:662-347-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor