Provider Demographics
NPI:1154100170
Name:ATKINS, STACEY (PHD, MSW, LMSW)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:ATKINS
Suffix:
Gender:F
Credentials:PHD, MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E LEIGH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-1306
Mailing Address - Country:US
Mailing Address - Phone:804-914-1392
Mailing Address - Fax:
Practice Address - Street 1:10 E LEIGH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1306
Practice Address - Country:US
Practice Address - Phone:804-914-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0903003592104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker