Provider Demographics
NPI:1902357742
Name:ROBINSON, MARVIA
Entity Type:Individual
Prefix:
First Name:MARVIA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 HOLDER DR
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-6837
Mailing Address - Country:US
Mailing Address - Phone:214-779-4063
Mailing Address - Fax:
Practice Address - Street 1:525 HOLDER DR
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-6837
Practice Address - Country:US
Practice Address - Phone:214-779-4063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171W00000X
253J00000X
TX373H00000X373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No253J00000XAgenciesFoster Care Agency
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist