Provider Demographics
NPI:1396409132
Name:ROBINSON, JENNIQUE A (ALC)
Entity Type:Individual
Prefix:
First Name:JENNIQUE
Middle Name:A
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 11TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2009
Mailing Address - Country:US
Mailing Address - Phone:256-654-1893
Mailing Address - Fax:
Practice Address - Street 1:198 US HIGHWAY 278 E
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-0690
Practice Address - Country:US
Practice Address - Phone:888-355-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3085A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor