Provider Demographics
NPI:1639602097
Name:WINKE, ROBIN KELLY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:KELLY
Last Name:WINKE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:WINKE, LMSW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:2701 TROY CENTER DR
Mailing Address - Street 2:SUITE 255
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4753
Mailing Address - Country:US
Mailing Address - Phone:248-558-2052
Mailing Address - Fax:248-816-1256
Practice Address - Street 1:2701 TROY CENTER DR
Practice Address - Street 2:SUITE 255
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4753
Practice Address - Country:US
Practice Address - Phone:248-558-2052
Practice Address - Fax:248-816-1256
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801098377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1639602097Medicaid