Provider Demographics
NPI:1336229442
Name:ATLAS, MARILYN S (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:S
Last Name:ATLAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816-F BRAWLEY SCHOOL ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6852
Mailing Address - Country:US
Mailing Address - Phone:704-658-9676
Mailing Address - Fax:704-799-3257
Practice Address - Street 1:816-F BRAWLEY SCHOOL ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6852
Practice Address - Country:US
Practice Address - Phone:704-658-9676
Practice Address - Fax:704-799-3257
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC004741101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106455Medicaid