Provider Demographics
NPI:1558415158
Name:ATKINSON, DEBORAH ALICE (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ALICE
Last Name:ATKINSON
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 1:1430 SUMMITT AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-4865
Mailing Address - Country:US
Mailing Address - Phone:910-429-0003
Mailing Address - Fax:910-323-1921
Practice Address - Street 1:1430 SUMMITT AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-4865
Practice Address - Country:US
Practice Address - Phone:910-429-0003
Practice Address - Fax:910-323-1921
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2325103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC213989OtherCOMPSYCH
NC04014OtherBCBS
NC213989OtherCOMPSYCH