Provider Demographics
NPI:1093094229
Name:ROBINSON, KATHY DENISE
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:DENISE
Last Name:ROBINSON
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 1:1088A PARK CIRCLE NW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-4446
Mailing Address - Country:US
Mailing Address - Phone:770-601-7784
Mailing Address - Fax:
Practice Address - Street 1:1088A PARK CIRCLE NW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-4446
Practice Address - Country:US
Practice Address - Phone:770-601-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional