Healthcare Provider Details

I. General information

NPI: 1356010565
Provider Name (Legal Business Name): EDDIE LEWIS ATKINS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 BELLEVUE ST SE
WASHINGTON DC
20032-6030
US

IV. Provider business mailing address

4228 WISCONSIN AVE NW
WASHINGTON DC
20016-2138
US

V. Phone/Fax

Practice location:
  • Phone: 202-562-4939
  • Fax:
Mailing address:
  • Phone: 202-247-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC1117
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: