Healthcare Provider Details

I. General information

NPI: 1043146004
Provider Name (Legal Business Name): BREVARD INSTITUTE FOR MENTAL HEALTH PROFESSIONALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 GOULD AVE SW
PALM BAY FL
32908-8118
US

IV. Provider business mailing address

3425 BAYSIDE LAKES BLVD SE STE 103
PALM BAY FL
32909-6867
US

V. Phone/Fax

Practice location:
  • Phone: 321-805-2982
  • Fax:
Mailing address:
  • Phone: 321-805-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROL EUEGENIE ATKINSON
Title or Position: MANAGER
Credential: PHD
Phone: 321-805-2982