Provider Demographics
NPI:1235639790
Name:MENG, ROBIN MICHELLE (CDP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:MICHELLE
Last Name:MENG
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 TACOMA AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5416
Mailing Address - Country:US
Mailing Address - Phone:253-502-5440
Mailing Address - Fax:253-272-6666
Practice Address - Street 1:510 TACOMA AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5416
Practice Address - Country:US
Practice Address - Phone:253-502-5440
Practice Address - Fax:253-272-6666
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60061821101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)