Provider Demographics
NPI:1053889238
Name:NATHAN, ATIYA (LCSW)
Entity type:Individual
Prefix:
First Name:ATIYA
Middle Name:
Last Name:NATHAN
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 1:2208 PASADENA CT UNIT 10
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2321
Mailing Address - Country:US
Mailing Address - Phone:859-533-8356
Mailing Address - Fax:
Practice Address - Street 1:240 EISENHOWER DR STE C2
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-3649
Practice Address - Country:US
Practice Address - Phone:228-424-3427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040107161041C0700X
CA1180071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical