Organization
ROBINWILD INTEGRATED MEDICINE LLC
Active
Other names
Robinwild Integrated Medicine LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANI WILDER (CFO)
(678) 651-4022
Entity
Organization
Contact information
Practice address
507 WATSON BAY, STONE MOUNTAIN, GA 30087-6121
(678) 651-4022
Mailing address
507 WATSON BAY, STONE MOUNTAIN, GA 30087-6121
(678) 651-4022
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TP0016X
Prescribing (Medical) Psychologist
—
—
Other
Enumeration date
03/08/2021
Last updated
03/08/2021
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