Provider Demographics
NPI:1154002814
Name:ROBINSON, MAEVE TERESA (LPC, CADC II)
Entity type:Individual
Prefix:
First Name:MAEVE
Middle Name:TERESA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LPC, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 LAVISTA DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-4071
Mailing Address - Country:US
Mailing Address - Phone:706-809-3213
Mailing Address - Fax:
Practice Address - Street 1:117 HISTORY ST
Practice Address - Street 2:
Practice Address - City:TIGER
Practice Address - State:GA
Practice Address - Zip Code:30576-2524
Practice Address - Country:US
Practice Address - Phone:706-809-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional