Provider Demographics
NPI:1184191850
Name:ROBINSON, DEIDRE J (LCPC)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:J
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 EASTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1544
Mailing Address - Country:US
Mailing Address - Phone:847-612-1307
Mailing Address - Fax:
Practice Address - Street 1:1830 SHERMAN AVE STE 404
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3774
Practice Address - Country:US
Practice Address - Phone:312-508-3542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012920101YP2500X
IL178.014183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional