Provider Demographics
NPI:1164067062
Name:JOHNSON, ROBIN FAYVONNE (LMSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:FAYVONNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 MILLARD ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2024
Mailing Address - Country:US
Mailing Address - Phone:512-333-1458
Mailing Address - Fax:
Practice Address - Street 1:930 S BELL BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3972
Practice Address - Country:US
Practice Address - Phone:512-333-1458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical