Provider Demographics
NPI:1417046962
Name:ROBBINS, VICKIE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICKIE
Middle Name:L
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MAULDIN LN
Mailing Address - Street 2:P.O BOX 1023
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-1544
Mailing Address - Country:US
Mailing Address - Phone:662-429-1824
Mailing Address - Fax:662-489-4817
Practice Address - Street 1:1012 IDA GRACE TRL
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-1010
Practice Address - Country:US
Practice Address - Phone:662-659-9230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS41676103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124635Medicaid