Provider Demographics
NPI:1487022307
Name:ROBINSON, LORRETTA ANN (BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:LORRETTA
Middle Name:ANN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 GATEWAY CTR STE E
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3939
Mailing Address - Country:US
Mailing Address - Phone:810-545-7230
Mailing Address - Fax:810-510-0988
Practice Address - Street 1:5400 GATEWAY CTR STE E
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3939
Practice Address - Country:US
Practice Address - Phone:810-545-7230
Practice Address - Fax:810-510-0988
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 247200000X
MI7401000815103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other