Provider Demographics
NPI:1558668186
Name:ATKINSON, CAROL (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RIALTO PL STE 704
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3071
Mailing Address - Country:US
Mailing Address - Phone:321-805-2982
Mailing Address - Fax:321-989-0229
Practice Address - Street 1:4801 S UNIVERSITY DR STE 126
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3832
Practice Address - Country:US
Practice Address - Phone:321-805-2982
Practice Address - Fax:321-989-0229
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2868106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003811600Medicaid