Provider Demographics
NPI:1225199870
Name:ROBINSON, DANETTA DUTTON (LCSW)
Entity Type:Individual
Prefix:
First Name:DANETTA
Middle Name:DUTTON
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LCSW
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 264
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28353-0264
Mailing Address - Country:US
Mailing Address - Phone:910-997-5980
Mailing Address - Fax:910-277-0172
Practice Address - Street 1:810 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-997-5980
Practice Address - Fax:910-277-0172
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC002030104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002479Medicaid
2863740Medicare ID - Type Unspecified