Provider Demographics
NPI:1790144202
Name:ROBINSON, JUSTIN
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 HICKORY AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-4068
Mailing Address - Country:US
Mailing Address - Phone:504-287-4160
Mailing Address - Fax:504-305-0454
Practice Address - Street 1:190 HICKORY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-4068
Practice Address - Country:US
Practice Address - Phone:504-287-4160
Practice Address - Fax:504-305-0454
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health