Provider Demographics
NPI:1467952374
Name:ATLAS CHILD COUNSELING, PLLC
Entity Type:Organization
Organization Name:ATLAS CHILD COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MSW, RPT
Authorized Official - Phone:910-224-2307
Mailing Address - Street 1:275 PINEHURST AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7138
Mailing Address - Country:US
Mailing Address - Phone:910-224-2307
Mailing Address - Fax:910-684-8206
Practice Address - Street 1:275 PINEHURST AVE STE A
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7138
Practice Address - Country:US
Practice Address - Phone:910-224-2307
Practice Address - Fax:910-684-8206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0088881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205244100Medicaid