Provider Demographics
NPI:1669527511
Name:ROBINSON, MARIA ANNALISE (LPC)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ANNALISE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 HEIGHTS LANE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525
Mailing Address - Country:US
Mailing Address - Phone:706-782-9758
Mailing Address - Fax:706-782-9758
Practice Address - Street 1:283 HEIGHTS LANE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525
Practice Address - Country:US
Practice Address - Phone:706-782-9758
Practice Address - Fax:706-782-9758
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004529101YP2500X, 101Y00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC004529OtherSTATE LICENSE COUNSELOR
GA775816127AMedicaid
GA775816127AMedicaid