Provider Demographics
NPI:1659402824
Name:MURPHY, ROBIN A
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:A
Last Name:MURPHY
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 1:14 N CHURCH ST
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3502
Mailing Address - Country:US
Mailing Address - Phone:803-435-2121
Mailing Address - Fax:
Practice Address - Street 1:14 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3502
Practice Address - Country:US
Practice Address - Phone:803-435-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC1106306101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1730176934Medicaid