Provider Demographics
NPI:1093018731
Name:MOSS, ROBIN SUZANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:SUZANNE
Last Name:MOSS
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 1:3001 HAMILL RD
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3321
Mailing Address - Country:US
Mailing Address - Phone:423-842-5757
Mailing Address - Fax:423-842-5785
Practice Address - Street 1:3001 HAMILL RD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3321
Practice Address - Country:US
Practice Address - Phone:423-842-5757
Practice Address - Fax:423-842-5785
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53601041C0700X
FL99771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical