Provider Demographics
NPI:1003359381
Name:ROBSON, JODY L (MA, LPC, CAADC)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:ROBSON
Suffix:
Gender:F
Credentials:MA, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-0561
Mailing Address - Country:US
Mailing Address - Phone:989-348-2544
Mailing Address - Fax:989-348-7617
Practice Address - Street 1:6459 W M 72 HWY
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-8021
Practice Address - Country:US
Practice Address - Phone:989-348-2544
Practice Address - Fax:989-348-7617
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009250101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)