Provider Demographics
NPI:1942504428
Name:ROBERSONVILLE PSYCHOSOCIAL REHABILITATION LLC
Entity Type:Organization
Organization Name:ROBERSONVILLE PSYCHOSOCIAL REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-714-1755
Mailing Address - Street 1:3709 BARTON WAY
Mailing Address - Street 2:
Mailing Address - City:GRIMESLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27837-9159
Mailing Address - Country:US
Mailing Address - Phone:252-714-1755
Mailing Address - Fax:252-329-2740
Practice Address - Street 1:3709 BARTON WAY
Practice Address - Street 2:
Practice Address - City:GRIMESLAND
Practice Address - State:NC
Practice Address - Zip Code:27837-9159
Practice Address - Country:US
Practice Address - Phone:252-714-1755
Practice Address - Fax:252-329-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health