Provider Demographics
NPI:1215594023
Name:ROBINSON, TANOVA CORNISE (MA)
Entity Type:Individual
Prefix:MS
First Name:TANOVA
Middle Name:CORNISE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 WISTERIA RD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3495
Mailing Address - Country:US
Mailing Address - Phone:843-797-7871
Mailing Address - Fax:843-797-8638
Practice Address - Street 1:96 WISTERIA ROAD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445
Practice Address - Country:US
Practice Address - Phone:843-797-7871
Practice Address - Fax:843-797-8638
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)