Provider Demographics
NPI:1568835403
Name:BLACKSTON, ROBINETA JOVONNE MONTELINA (LCSW-A)
Entity Type:Individual
Prefix:MS
First Name:ROBINETA
Middle Name:JOVONNE MONTELINA
Last Name:BLACKSTON
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 TUSKEEGEE ST SE
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-6490
Mailing Address - Country:US
Mailing Address - Phone:252-292-8796
Mailing Address - Fax:
Practice Address - Street 1:1420A S POLLOCK ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576-3404
Practice Address - Country:US
Practice Address - Phone:919-351-0428
Practice Address - Fax:919-351-0814
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-31
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0094801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical