MEDICARE: ANDREA ROBINSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	4907	CO
2	106H00000X	Marriage & Family Therapist	4907	CO
3	101YM0800X	Mental Health Counselor	LPC007164	GA

General Provider Information

NPI Number	:	1184995839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA ROBINSON LPC

Provider Business Mailing Address
First Line	:	1276 MCCONNELL DRIVE, STE. A
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3533
Country	:	US
Telephone Number	:	470-485-2150
Fax Number	:

Provider Business Practice Location Address
First Line	:	1276 MCCONNELL DR STE A
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3533
Country	:	US
Telephone Number	:	470-485-2150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2012
Last Update Date	:	09/10/2018

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