Provider Demographics
NPI:1639646185
Name:ATLAS PSYCHOLOGICAL PC
Entity Type:Organization
Organization Name:ATLAS PSYCHOLOGICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:ATLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-806-3214
Mailing Address - Street 1:10800 SIKES PL STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8124
Mailing Address - Country:US
Mailing Address - Phone:704-806-3214
Mailing Address - Fax:
Practice Address - Street 1:10800 SIKES PL STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8124
Practice Address - Country:US
Practice Address - Phone:704-806-3214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty