Provider Demographics
NPI:1619308491
Name:AKINS, CONRAD PAUL (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:PAUL
Last Name:AKINS
Suffix:
Gender:M
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:CONRAD
Other - Middle Name:PAUL
Other - Last Name:AKINS-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, MSW
Mailing Address - Street 1:2085 RUSTIN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2498
Mailing Address - Country:US
Mailing Address - Phone:951-955-7320
Mailing Address - Fax:
Practice Address - Street 1:24275 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-7285
Practice Address - Country:US
Practice Address - Phone:951-677-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1008791041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical