Provider Demographics
NPI:1598507782
Name:ATKINS, LORI KATHRYN
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:KATHRYN
Last Name:ATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 PINEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35905-7205
Mailing Address - Country:US
Mailing Address - Phone:256-691-4364
Mailing Address - Fax:
Practice Address - Street 1:200 VESTAVIA PKWY STE 2400
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3797
Practice Address - Country:US
Practice Address - Phone:205-208-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24-349494106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician