Provider Demographics
NPI:1093491375
Name:ROBINSON, LATONYA MICHELLE
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:MICHELLE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 JACKSON FARM LN
Mailing Address - Street 2:
Mailing Address - City:BUMPASS
Mailing Address - State:VA
Mailing Address - Zip Code:23024-3235
Mailing Address - Country:US
Mailing Address - Phone:804-441-1786
Mailing Address - Fax:
Practice Address - Street 1:345 JACKSON FARM LANE
Practice Address - Street 2:
Practice Address - City:BUMPASS
Practice Address - State:VA
Practice Address - Zip Code:23024
Practice Address - Country:US
Practice Address - Phone:804-441-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2755251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health