Provider Demographics
NPI:1275694481
Name:WEATHERS, ROBERT STANLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STANLEY
Last Name:WEATHERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 TECHNOLOGY DR STE 173
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2328
Mailing Address - Country:US
Mailing Address - Phone:310-383-7532
Mailing Address - Fax:
Practice Address - Street 1:16 TECHNOLOGY DR STE 173
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2328
Practice Address - Country:US
Practice Address - Phone:310-383-7532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)