Healthcare Provider Details

I. General information

NPI: 1083070304
Provider Name (Legal Business Name): BRENDA DARLENE ATKINSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 KIDSPEACE DR
BOWDON GA
30108-3447
US

IV. Provider business mailing address

102 PINNACLE WAY
CARROLLTON GA
30117-5254
US

V. Phone/Fax

Practice location:
  • Phone: 770-437-7237
  • Fax: 770-258-9128
Mailing address:
  • Phone: 404-434-0618
  • Fax: 770-258-9128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004649
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: