Provider Demographics
NPI:1861454720
Name:EZZELL, ROBYN FORD (MA, LPA)
Entity Type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:FORD
Last Name:EZZELL
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 ROCKING ROBYN RUN
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-8716
Mailing Address - Country:US
Mailing Address - Phone:919-266-4358
Mailing Address - Fax:919-217-0820
Practice Address - Street 1:3812 ROCKING ROBYN RUN
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8716
Practice Address - Country:US
Practice Address - Phone:919-266-4358
Practice Address - Fax:919-217-0820
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2256103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107160Medicaid