Provider Demographics
NPI:1609995745
Name:REA, ROBINSON MOORHEAD
Entity Type:Individual
Prefix:MS
First Name:ROBINSON
Middle Name:MOORHEAD
Last Name:REA
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 1:29 RAVENSCROFT DR STE 103
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3602
Mailing Address - Country:US
Mailing Address - Phone:310-930-5876
Mailing Address - Fax:
Practice Address - Street 1:29 RAVENSCROFT DR STE 103
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3602
Practice Address - Country:US
Practice Address - Phone:310-930-5876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42618106H00000X
NC1865106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist