Healthcare Provider Details

I. General information

NPI: 1669983979
Provider Name (Legal Business Name): SANDRA ATKISSON MS, LSW, CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2017
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MARTIN LUTHER KING DR E
CINCINNATI OH
45219-2581
US

IV. Provider business mailing address

3009 BURNET AVE
CINCINNATI OH
45220-2419
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-5300
  • Fax:
Mailing address:
  • Phone: 513-332-0350
  • Fax: 513-332-0368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberS26342
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: