| Doctor Name: | DEADRA CARNACK ATKINS |
| NPI Number: | 1033237771 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW-C |
| License Number: | 4752 |
| Business Practice Address: | 122 Langley Rd N Suite A Glen Burnie, MD - 210606539 |
| Business Phone Number: | 4102226785 |
| Business Fax Number: | |
| Mailing Address: | 6936 Knighthood Ln, COLUMBIA |
| State: | MD |
| Postal Code: | 210454801 |
| Phone Number: | 4103810559 |
| Fax Number: | |
| NPI Enumeration Date: | 03/27/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 4752 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |