Provider Demographics
NPI:1669983979
Name:ATKISSON, SANDRA (MS, LSW, CDCA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ATKISSON
Suffix:
Gender:F
Credentials:MS, LSW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2419
Mailing Address - Country:US
Mailing Address - Phone:513-332-0350
Mailing Address - Fax:513-332-0368
Practice Address - Street 1:311 MARTIN LUTHER KING DR E
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2581
Practice Address - Country:US
Practice Address - Phone:513-475-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-14
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS26342101YA0400X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)