Provider Demographics
NPI:1790858405
Name:ROBBINS, JUANITA DUERKOP (LISW, CP&AP)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:DUERKOP
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:LISW, CP&AP
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:
Other - Last Name:DUERKOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW, CP&AP
Mailing Address - Street 1:117 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3764
Mailing Address - Country:US
Mailing Address - Phone:843-899-4949
Mailing Address - Fax:843-899-7224
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3764
Practice Address - Country:US
Practice Address - Phone:843-899-4949
Practice Address - Fax:843-899-7224
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0057491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ325507848Medicare PIN