Healthcare Provider Details

I. General information

NPI: 1841969417
Provider Name (Legal Business Name): BRIA DANIELLE ATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E 55TH ST STE 301-B
CHICAGO IL
60615-5512
US

IV. Provider business mailing address

PO BOX 4426
CHICAGO IL
60680-4426
US

V. Phone/Fax

Practice location:
  • Phone: 708-831-1445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.017326
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: