Healthcare Provider Details

I. General information

NPI: 1245285626
Provider Name (Legal Business Name): GREGORY HOWARD ROBINSON MAMFC MARE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2622 HAYNES LN
CAYCE SC
29033-2126
US

IV. Provider business mailing address

2622 HAYNES LN
CAYCE SC
29033-2126
US

V. Phone/Fax

Practice location:
  • Phone: 803-238-1911
  • Fax:
Mailing address:
  • Phone: 803-238-1911
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3936
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: