Provider Demographics
NPI:1396986907
Name:ROBINSON, WILLIAM DAVID JR (CAC-R, CCJP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVID
Last Name:ROBINSON
Suffix:JR
Gender:M
Credentials:CAC-R, CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12305 DEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1015
Mailing Address - Country:US
Mailing Address - Phone:313-397-1306
Mailing Address - Fax:313-397-6010
Practice Address - Street 1:12305 DEXTER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1015
Practice Address - Country:US
Practice Address - Phone:313-397-1306
Practice Address - Fax:313-397-6010
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)