Provider Demographics
NPI:1578070041
Name:ROBINSON, KIMBERLY LOIS
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LOIS
Last Name:ROBINSON
Suffix:
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 1:322 HEYMANN BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2465
Mailing Address - Country:US
Mailing Address - Phone:337-446-4707
Mailing Address - Fax:337-446-4715
Practice Address - Street 1:203 PINTO ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506
Practice Address - Country:US
Practice Address - Phone:337-212-4425
Practice Address - Fax:337-212-4425
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health