Provider Demographics
NPI:1477274850
Name:ROBILOTTO BASS, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:ROBILOTTO BASS
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 1:37 CALUMET PKWY BLDG J
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6734
Mailing Address - Country:US
Mailing Address - Phone:770-683-6946
Mailing Address - Fax:770-683-6949
Practice Address - Street 1:37 CALUMET PKWY BLDG J
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6734
Practice Address - Country:US
Practice Address - Phone:770-683-6946
Practice Address - Fax:770-683-6949
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health