Provider Demographics
NPI:1598955411
Name:ATKINSON, FANTA KIZZY (MA)
Entity Type:Individual
Prefix:MISS
First Name:FANTA
Middle Name:KIZZY
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 STETSON ST
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-2439
Mailing Address - Country:US
Mailing Address - Phone:617-479-1876
Mailing Address - Fax:
Practice Address - Street 1:61 STETSON ST
Practice Address - Street 2:
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382-2439
Practice Address - Country:US
Practice Address - Phone:617-479-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health