Provider Demographics
NPI:1235788647
Name:MIRASSOU, ROBYN ANN (LPCA)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:ANN
Last Name:MIRASSOU
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7489 ROCKFISH RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6131
Mailing Address - Country:US
Mailing Address - Phone:910-584-6739
Mailing Address - Fax:833-260-0543
Practice Address - Street 1:7489 ROCKFISH RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-6131
Practice Address - Country:US
Practice Address - Phone:910-584-6739
Practice Address - Fax:833-260-0543
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health