Provider Demographics
NPI:1801253604
Name:ROBINSON, ANGEL LYNETT
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:LYNETT
Last Name:ROBINSON
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 1:107 SHEPHERD DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4203
Mailing Address - Country:US
Mailing Address - Phone:678-328-7775
Mailing Address - Fax:
Practice Address - Street 1:3330 CUMBERLAND BLVD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5995
Practice Address - Country:US
Practice Address - Phone:678-638-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker