Provider Demographics
NPI:1811219421
Name:ROBY, EARNESTINE YVETT (MS)
Entity Type:Individual
Prefix:
First Name:EARNESTINE
Middle Name:YVETT
Last Name:ROBY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 BLUECUTT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1325
Mailing Address - Country:US
Mailing Address - Phone:662-368-2177
Mailing Address - Fax:
Practice Address - Street 1:3504 BLUECUTT RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1325
Practice Address - Country:US
Practice Address - Phone:662-368-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MS1570101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health