Healthcare Provider Details

I. General information

NPI: 1821910647
Provider Name (Legal Business Name): TAWANDA VICTORIA SHANAY ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH ST STE 100B
GARDENA CA
90248-4320
US

IV. Provider business mailing address

PO BOX 313
LOMITA CA
90717-0313
US

V. Phone/Fax

Practice location:
  • Phone: 562-306-2925
  • Fax: 833-729-4328
Mailing address:
  • Phone: 310-625-1612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT163611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: