Healthcare Provider Details

I. General information

NPI: 1538369442
Provider Name (Legal Business Name): ATLAS COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 BRAWLEY SCHOOL RD STE F 4
MOORESVILLE NC
28117-6201
US

IV. Provider business mailing address

816 BRAWLEY SCHOOL RD STE F 4
MOORESVILLE NC
28117-6201
US

V. Phone/Fax

Practice location:
  • Phone: 704-658-9676
  • Fax: 704-799-3258
Mailing address:
  • Phone: 704-658-9676
  • Fax: 704-799-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004741
License Number StateNC

VIII. Authorized Official

Name: MS. MARILYN S ATLAS
Title or Position: MANAGER PSYCHOTHERAPIST
Credential: LCSW
Phone: 704-658-9676