Provider Demographics
NPI:1356861728
Name:VAN SANT, ROBIN LAUREL
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LAUREL
Last Name:VAN SANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 S SHARON AMITY RD STE D
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2856
Mailing Address - Country:US
Mailing Address - Phone:704-517-2106
Mailing Address - Fax:
Practice Address - Street 1:419 S SHARON AMITY RD STE D
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2856
Practice Address - Country:US
Practice Address - Phone:704-517-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0124451041C0700X
NCP0114451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical