Provider Demographics
NPI:1942321377
Name:ROBINSON, CAROL SUE
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:SUE
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 1:1400 W MINTHORN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2808
Mailing Address - Country:US
Mailing Address - Phone:951-245-3201
Mailing Address - Fax:951-245-3008
Practice Address - Street 1:1400 W MINTHORN ST
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2808
Practice Address - Country:US
Practice Address - Phone:951-245-3201
Practice Address - Fax:951-245-3008
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT112348106H00000X
101YA0400X
CAIMF74634101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health