Provider Demographics
NPI:1477013944
Name:ROBINSON, WONAKEE TERRISITA JR
Entity Type:Individual
Prefix:MS
First Name:WONAKEE
Middle Name:TERRISITA
Last Name:ROBINSON
Suffix:JR
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 1:5950 DRURY LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63147-1112
Mailing Address - Country:US
Mailing Address - Phone:314-269-7099
Mailing Address - Fax:
Practice Address - Street 1:5950 DRURY LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63147-1112
Practice Address - Country:US
Practice Address - Phone:314-269-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO123898101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMOOther46678898