Provider Demographics
NPI:1932321650
Name:ROBINSON, WILLIE DREW
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:DREW
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 1:9100 BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-4000
Mailing Address - Country:US
Mailing Address - Phone:925-809-7920
Mailing Address - Fax:925-809-7928
Practice Address - Street 1:9100 BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4000
Practice Address - Country:US
Practice Address - Phone:925-809-7920
Practice Address - Fax:925-809-7928
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA07556OtherBYRON ADOLESCENT
CA070726OtherMASTER PROVIDER NUMBER
CA070753OtherMASTER PROVIDER NO
CA07553OtherBRENTWOOD ADOLESCENT
CA07536OtherDMC ADOL ANTIOCH
CA56680OtherSTAFF ID NUMBER
CA0753OtherDRUG MEDI-CAL NO
CA07557OtherDMC ADOL BRENTWOOD
CA0726OtherDRUG M/CAL BILLING NUM