Provider Demographics
NPI:1235249574
Name:ROBINSON, TINA ANN (MSW LCSW C-ASWCM)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:ANN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MSW LCSW C-ASWCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4034 WOODLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-9622
Mailing Address - Country:US
Mailing Address - Phone:770-778-1201
Mailing Address - Fax:770-834-2920
Practice Address - Street 1:195 LITTLE RIVER RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-7695
Practice Address - Country:US
Practice Address - Phone:770-834-8957
Practice Address - Fax:770-834-2920
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CSW000382104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBFCDMedicare ID - Type Unspecified
S90983Medicare UPIN