Provider Demographics
NPI:1922319151
Name:MAYNARD-DOBBS, ROBIN ALEXIS (CHT, CC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ALEXIS
Last Name:MAYNARD-DOBBS
Suffix:
Gender:F
Credentials:CHT, CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 NW 103RD ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-4938
Mailing Address - Country:US
Mailing Address - Phone:206-789-1764
Mailing Address - Fax:206-781-5923
Practice Address - Street 1:322 NW 103RD ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98177-4938
Practice Address - Country:US
Practice Address - Phone:206-789-1764
Practice Address - Fax:206-781-5923
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60148049101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor