Provider Demographics
NPI:1437744299
Name:CARRIE CRAGUN-ATCHISON, PHD, LLC
Entity Type:Organization
Organization Name:CARRIE CRAGUN-ATCHISON, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CRAGUN-ATCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-372-8141
Mailing Address - Street 1:1719 FELCH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5406
Mailing Address - Country:US
Mailing Address - Phone:518-598-6264
Mailing Address - Fax:
Practice Address - Street 1:2523 HERSCHEL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4509
Practice Address - Country:US
Practice Address - Phone:904-372-8141
Practice Address - Fax:855-933-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty