Provider Demographics
NPI:1205915402
Name:ROBERTSON, WARNIE MITCHELL (MITCH) (LICSW)
Entity type:Individual
Prefix:
First Name:WARNIE
Middle Name:MITCHELL (MITCH)
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35612-1289
Mailing Address - Country:US
Mailing Address - Phone:256-874-4159
Mailing Address - Fax:
Practice Address - Street 1:600 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-3506
Practice Address - Country:US
Practice Address - Phone:256-850-4091
Practice Address - Fax:256-970-1643
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLGSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker