Provider Demographics
NPI:1417223124
Name:ATKINSON, AUDREY NICOLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:NICOLE
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 NORTHEAST DR STE 102
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7437
Mailing Address - Country:US
Mailing Address - Phone:980-221-2113
Mailing Address - Fax:
Practice Address - Street 1:903 NORTHEAST DR STE 102
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7437
Practice Address - Country:US
Practice Address - Phone:980-221-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4510103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist