Provider Demographics
NPI:1629569280
Name:ROBINSON, NYESHA SHANTA (LCASA)
Entity Type:Individual
Prefix:MISS
First Name:NYESHA
Middle Name:SHANTA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 MERIDIAN PKWY STE 2055
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5272
Mailing Address - Country:US
Mailing Address - Phone:919-672-2407
Mailing Address - Fax:866-770-5166
Practice Address - Street 1:2530 MERIDIAN PKWY STE 2055
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5272
Practice Address - Country:US
Practice Address - Phone:919-672-2407
Practice Address - Fax:866-770-5166
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-19
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24570101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)