Provider Demographics
NPI:1578738431
Name:ATKINS, JUDY LEIGH (MA,TLLP,CAAC)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LEIGH
Last Name:ATKINS
Suffix:
Gender:F
Credentials:MA,TLLP,CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26862 WOODWARD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0957
Mailing Address - Country:US
Mailing Address - Phone:248-398-0740
Mailing Address - Fax:248-398-9456
Practice Address - Street 1:26862 WOODWARD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0957
Practice Address - Country:US
Practice Address - Phone:248-398-0740
Practice Address - Fax:248-398-9456
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical