Provider Demographics
NPI:1700152139
Name:ATKINSON, LISA CATHERINE
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:CATHERINE
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 KIT CARSON WAY APT B
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3569
Mailing Address - Country:US
Mailing Address - Phone:916-740-2853
Mailing Address - Fax:530-886-2895
Practice Address - Street 1:1611 KIT CARSON WAY APT B
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3569
Practice Address - Country:US
Practice Address - Phone:916-740-2853
Practice Address - Fax:530-886-2895
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist