Provider Demographics
NPI:1609411057
Name:ROBINSON, MICHELLE BERNICE
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:BERNICE
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 1:2209 E LELAND RD APT 19
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5130
Mailing Address - Country:US
Mailing Address - Phone:209-445-4251
Mailing Address - Fax:
Practice Address - Street 1:2209 E LELAND RD APT 19
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5130
Practice Address - Country:US
Practice Address - Phone:209-445-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional