Provider Demographics
NPI:1356914451
Name:OWENS, ROBERT ELLIOTT (EDD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELLIOTT
Last Name:OWENS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 NANDINA DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2766
Mailing Address - Country:US
Mailing Address - Phone:336-355-0978
Mailing Address - Fax:
Practice Address - Street 1:12 NANDINA DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2766
Practice Address - Country:US
Practice Address - Phone:336-355-0978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health