Provider Demographics
NPI:1023855673
Name:ATKINS, SAMANTHA JO LEE ANN (LCSW-A)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO LEE ANN
Last Name:ATKINS
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 COTTAGE PL APT F
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2328
Mailing Address - Country:US
Mailing Address - Phone:276-237-9043
Mailing Address - Fax:
Practice Address - Street 1:411 DOLLEY MADISON RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-5142
Practice Address - Country:US
Practice Address - Phone:336-663-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0207091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical