Provider Demographics
NPI:1598871386
Name:ATKINSON, LAVON (PSY D)
Entity Type:Individual
Prefix:
First Name:LAVON
Middle Name:
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7704 PATUXENT OAK CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6172
Mailing Address - Country:US
Mailing Address - Phone:443-676-1638
Mailing Address - Fax:
Practice Address - Street 1:405 N PACA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1815
Practice Address - Country:US
Practice Address - Phone:443-676-1638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical