Provider Demographics
NPI:1164748265
Name:ROBSON, KRISTIN (BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ROBSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 1165
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063
Mailing Address - Country:US
Mailing Address - Phone:843-312-2832
Mailing Address - Fax:803-753-9111
Practice Address - Street 1:2580 LIN DO CT
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1832
Practice Address - Country:US
Practice Address - Phone:803-905-4427
Practice Address - Fax:803-905-4431
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1084676103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst