Healthcare Provider Details

I. General information

NPI: 1558541912
Provider Name (Legal Business Name): ROBIN HIERS MIXON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 CORDER RD STE 200
WARNER ROBINS GA
31088-7165
US

IV. Provider business mailing address

121 CARL VINSON PKWY
WARNER ROBINS GA
31088-5817
US

V. Phone/Fax

Practice location:
  • Phone: 912-509-2119
  • Fax: 478-551-4718
Mailing address:
  • Phone: 478-922-2365
  • Fax: 478-922-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003675
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: