Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OTA001894 | GA |
NPI | 1720467517 |
---|---|
Provider Name | Ms. Chontanite Robinson |
First Address | Louisville, KY 40211-2749 |
Second Address | Athens, GA 30601-2646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2015 |
Last Update Date | 26/05/2015 |