Provider Demographics
NPI:1619551561
Name:ODONNELL, ROBIN JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:JANE
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 CHARLOTTES WALK
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:GA
Mailing Address - Zip Code:30621-1567
Mailing Address - Country:US
Mailing Address - Phone:706-546-6733
Mailing Address - Fax:
Practice Address - Street 1:1467 CHARLOTTES WALK
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:GA
Practice Address - Zip Code:30621-1567
Practice Address - Country:US
Practice Address - Phone:706-546-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0075481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty