Provider Demographics
NPI:1942643879
Name:ROBINSON, MACQUANETTA DENISE (LCSW)
Entity Type:Individual
Prefix:
First Name:MACQUANETTA
Middle Name:DENISE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MACKIE
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5325 OLD HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3244
Mailing Address - Country:US
Mailing Address - Phone:423-544-2773
Mailing Address - Fax:866-446-0276
Practice Address - Street 1:5325 OLD HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3244
Practice Address - Country:US
Practice Address - Phone:423-544-2773
Practice Address - Fax:866-446-0276
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN74721041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ081934Medicaid