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General NPI Number Information
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NPI Number | 1821688706
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Entity Type | Organization
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Legal Business Name | ROBINWILDE INTEGRATED MEDICINE, LLLP
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 507 WATSON BAY
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-6121
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Country | US
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Telephone | 678-651-4022
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Fax |
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Provider Business Mailing Address
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Address Line | 507 WATSON BAY
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-6121
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Country | US
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Telephone | 678-651-4022
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LADEANA NICOLE ROBINSON
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Credential |
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Telephone | 470-364-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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