Basic Information
Provider Information
NPI: 1447417274
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ATKINSON
FirstName: CHRISTA
MiddleName: A
NamePrefix: MS.
NameSuffix:  
Credential: M.S.W.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 136 EAST CHAPEL HILL ST.
Address2: EL FUTURO
City: DURHAM
State: NC
PostalCode: 27701
CountryCode: US
TelephoneNumber: 9196887101
FaxNumber: 9196887102
Practice Location
Address1: 110 W MAIN ST
Address2: 2H
City: CARRBORO
State: NC
PostalCode: 275102026
CountryCode: US
TelephoneNumber: 9193381939
FaxNumber: 9193382729
Other Information
ProviderEnumerationDate: 05/20/2008
LastUpdateDate: 11/11/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XP004072NCY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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