Provider Demographics
NPI:1194738047
Name:MCKENNA, ROBIN POWERS (MSW LISW CP)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:POWERS
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MSW LISW CP
Other - Prefix:MISS
Other - First Name:ROBIN
Other - Middle Name:LEE
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54 WOODVALE AVENUE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605
Mailing Address - Country:US
Mailing Address - Phone:864-250-0764
Mailing Address - Fax:864-239-6968
Practice Address - Street 1:7C CLEVELAND COURT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-239-2200
Practice Address - Fax:864-239-6968
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC56531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQM0440Medicaid
SCQM0440Medicaid