Provider Demographics
NPI:1841556420
Name:ROBINSON, PHYLLIS Q (LPC)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:Q
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 OLD LEE HWY
Mailing Address - Street 2:SUITE 83 A
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2430
Mailing Address - Country:US
Mailing Address - Phone:703-408-6755
Mailing Address - Fax:703-352-8805
Practice Address - Street 1:3919 OLD LEE HWY
Practice Address - Street 2:SUITE 83 A
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2430
Practice Address - Country:US
Practice Address - Phone:703-408-6755
Practice Address - Fax:703-352-8805
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-08
Last Update Date:2012-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003491101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor