Provider Demographics
NPI:1629562228
Name:ROBBINS, SHELBY A (CSAC)
Entity Type:Individual
Prefix:MISS
First Name:SHELBY
Middle Name:A
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4931
Mailing Address - Country:US
Mailing Address - Phone:920-435-2093
Mailing Address - Fax:
Practice Address - Street 1:630 CHERRY ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4931
Practice Address - Country:US
Practice Address - Phone:920-435-2093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18576-130101YA0400X
WI16556-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)