Provider Demographics
NPI:1346569761
Name:ROBINSON, LEVI JR (LADAC)
Entity Type:Individual
Prefix:MR
First Name:LEVI
Middle Name:
Last Name:ROBINSON
Suffix:JR
Gender:M
Credentials:LADAC
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 16217
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38186-0217
Mailing Address - Country:US
Mailing Address - Phone:901-345-1236
Mailing Address - Fax:901-345-1735
Practice Address - Street 1:3385 AIRWAYS BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-3841
Practice Address - Country:US
Practice Address - Phone:901-345-1236
Practice Address - Fax:901-345-1735
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000001018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506838Medicare PIN