Provider Demographics
NPI:1891353835
Name:CONRAD, ROBIN CAROL (LPC, RN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:CAROL
Last Name:CONRAD
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 MOREY PL
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2747
Mailing Address - Country:US
Mailing Address - Phone:570-898-4707
Mailing Address - Fax:
Practice Address - Street 1:2600 MEMORIAL AVE STE 104
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2658
Practice Address - Country:US
Practice Address - Phone:434-528-4580
Practice Address - Fax:434-528-4584
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007957101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional