Provider Demographics
NPI:1538369442
Name:ATLAS COUNSELING PLLC
Entity type:Organization
Organization Name:ATLAS COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ATLAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-658-9676
Mailing Address - Street 1:816 BRAWLEY SCHOOL RD STE F
Mailing Address - Street 2:4
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6201
Mailing Address - Country:US
Mailing Address - Phone:704-658-9676
Mailing Address - Fax:704-799-3258
Practice Address - Street 1:816 BRAWLEY SCHOOL RD STE F
Practice Address - Street 2:4
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6201
Practice Address - Country:US
Practice Address - Phone:704-658-9676
Practice Address - Fax:704-799-3258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0047411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106455Medicaid
NC143NJOtherBCBS NC