Provider Demographics
NPI:1336173756
Name:WILLIAMS, ROBIN A (PHD,LCSW,)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD,LCSW,
Other - Prefix:DR
Other - First Name:ROBIN
Other - Middle Name:ALLEN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:230 W SUPERIOR ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-4021
Mailing Address - Country:US
Mailing Address - Phone:218-341-9158
Mailing Address - Fax:
Practice Address - Street 1:230 W SUPERIOR ST STE 400
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802
Practice Address - Country:US
Practice Address - Phone:218-341-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113291041C0700X
VA0710102819101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43594600Medicaid