Healthcare Provider Details

I. General information

NPI: 1265343487
Provider Name (Legal Business Name): ROBIN WINGATE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 HIGHLAND FALLS BLVD
HIRAM GA
30141-4135
US

IV. Provider business mailing address

287 HIGHLAND FALLS BLVD
HIRAM GA
30141-4135
US

V. Phone/Fax

Practice location:
  • Phone: 770-842-4940
  • Fax:
Mailing address:
  • Phone: 770-842-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0903004184
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW2143080
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW004793
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: