Provider Demographics
NPI:1275690455
Name:ROBINSON, BETTY J (LPC)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:J
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4389 INDIAN TRAIL FAIRVIEW RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-9639
Mailing Address - Country:US
Mailing Address - Phone:704-882-7716
Mailing Address - Fax:888-882-7113
Practice Address - Street 1:4389 INDIAN TRAIL FAIRVIEW RD
Practice Address - Street 2:SUITE 13
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-9639
Practice Address - Country:US
Practice Address - Phone:704-882-7716
Practice Address - Fax:888-882-7113
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3661101YM0800X
FL5588101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005126Medicaid
MAGELLANOther283541000
VALUEOPTIONSOther006516
BCBSOther133U5
VMCOther023658
CAQHOther11338543