Basic Information
Provider Information
NPI: 1386929073
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAY
FirstName: ROBIN
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2215
Address2:  
City: LITHONIA
State: GA
PostalCode: 300581046
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 465 WINN WAY
Address2: SUITE 221
City: DECATUR
State: GA
PostalCode: 300301753
CountryCode: US
TelephoneNumber: 4042923810
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/13/2011
LastUpdateDate: 06/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XLPC006524GAY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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