Provider Demographics
NPI:1710463633
Name:SHANKIN, ROBIN SUZANNE MCCOY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:SUZANNE MCCOY
Last Name:SHANKIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:SUZANNE
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:5254 KNOLL PLACE DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7518
Mailing Address - Country:US
Mailing Address - Phone:586-817-0417
Mailing Address - Fax:
Practice Address - Street 1:300 68TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-6927
Practice Address - Country:US
Practice Address - Phone:616-455-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6352000836103T00000X
MI6401015266101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor