Provider Demographics
NPI:1316446933
Name:ROBINSON, JAIRUS DANIEL (LCSW)
Entity type:Individual
Prefix:
First Name:JAIRUS
Middle Name:DANIEL
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1878 WESTON LN
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5500
Mailing Address - Country:US
Mailing Address - Phone:404-202-0056
Mailing Address - Fax:470-514-5912
Practice Address - Street 1:1878 WESTON LN
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5500
Practice Address - Country:US
Practice Address - Phone:404-860-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0060871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical