Doctor Name: | GWEN DELL ROBINSON |
NPI Number: | 1013377001 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 319 Elm Dr Villa Rica, GA - 301801913 |
Business Phone Number: | 7703099333 |
Business Fax Number: | |
Mailing Address: | 319 Elm Dr, VILLA RICA |
State: | GA |
Postal Code: | 301801913 |
Phone Number: | 7703099333 |
Fax Number: | |
NPI Enumeration Date: | 03/03/2016 |
NPI Last Update Date: | 03/03/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |