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General NPI Number Information
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NPI Number | 1538780960
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Entity Type | Organization
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Legal Business Name | MMRG LLC
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 05/01/2020
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Provider Practice Location Address
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Address Line | 3085 WOODMAN DR STE 205
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City | DAYTON
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State | OH
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Zip | 45420-1171
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Country | US
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Telephone | 937-204-9059
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 DOVETREE BLVD APT 19
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City | MORAINE
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State | OH
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Zip | 45439-5182
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Country | US
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Telephone | 937-204-9059
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIAN ROBINSON-GAY
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Credential | MSW, LSW
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Telephone | 937-204-9059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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