Healthcare Provider Details

I. General information

NPI: 1477274850
Provider Name (Legal Business Name): LEAH ROBILOTTO BASS LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CALUMET PKWY BLDG J
NEWNAN GA
30263-6734
US

IV. Provider business mailing address

2200 N A W GRIMES BLVD STE 600
ROUND ROCK TX
78665-2745
US

V. Phone/Fax

Practice location:
  • Phone: 770-683-6946
  • Fax: 770-683-6949
Mailing address:
  • Phone: 512-655-3104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: