Provider Demographics
NPI:1558894162
Name:ATKINSON, LEA (MA, LADC, LPCC)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:MA, LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10650 COUNTY ROAD 81
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4075
Mailing Address - Country:US
Mailing Address - Phone:763-313-7248
Mailing Address - Fax:
Practice Address - Street 1:10650 COUNTY ROAD 81
Practice Address - Street 2:SUITE 205
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4075
Practice Address - Country:US
Practice Address - Phone:763-313-7248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304506101YA0400X
MNCC01559101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty