Provider Demographics
NPI:1487838405
Name:ATKINS, GARY ROBERT (LCSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ROBERT
Last Name:ATKINS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALNUT COVE
Mailing Address - State:NC
Mailing Address - Zip Code:27052-9247
Mailing Address - Country:US
Mailing Address - Phone:336-753-2655
Mailing Address - Fax:336-217-1282
Practice Address - Street 1:522 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT COVE
Practice Address - State:NC
Practice Address - Zip Code:27052-9247
Practice Address - Country:US
Practice Address - Phone:336-753-2655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28294101YA0400X
CA051108101YA0400X
NCC0142891041C0700X
CA755091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)