Provider Demographics
NPI:1619653268
Name:ROBINSON, ANITA LINA (CHES, CCHW)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:LINA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:CHES, CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 WINFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3731
Mailing Address - Country:US
Mailing Address - Phone:240-626-1125
Mailing Address - Fax:
Practice Address - Street 1:1711 WINFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3731
Practice Address - Country:US
Practice Address - Phone:240-626-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD33323171400000X, 174H00000X
MD00388-20-A172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health Worker