Provider Demographics
NPI:1922501998
Name:ROBINSON, CARL ALBERT (SUDP, MSW)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:ALBERT
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:SUDP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E FOURTH PLAIN BLVD BLDG 17
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3717
Mailing Address - Country:US
Mailing Address - Phone:360-397-8488
Mailing Address - Fax:360-397-8492
Practice Address - Street 1:2410 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4630
Practice Address - Country:US
Practice Address - Phone:360-729-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABHA.FS.61435115251S00000X
WACO60881922101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1558412320Medicaid