Provider Demographics
NPI:1437637857
Name:HORRELL, ROBIN NOEL (LICSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:NOEL
Last Name:HORRELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:NOEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-339-5453
Mailing Address - Fax:425-252-4441
Practice Address - Street 1:1728 W MARINE VIEW DR STE 106
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:425-339-5453
Practice Address - Fax:425-252-4441
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60342573104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker