Provider Demographics
NPI:1508458464
Name:MCDAVID-RANSOM, ROBIN (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:MCDAVID-RANSOM
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 HARWOOD RD
Mailing Address - Street 2:STE 309 PMB 1012
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2113 HARWOOD RD
Practice Address - Street 2:STE 309 PMB 1012
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-7602
Practice Address - Country:US
Practice Address - Phone:817-242-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
TX77963101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)