Provider Demographics
NPI:1457139651
Name:BOULWARE-ABRAHAM, ROBIN VANESSA
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:VANESSA
Last Name:BOULWARE-ABRAHAM
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 1:2901 COLTSGATE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4384
Mailing Address - Country:US
Mailing Address - Phone:704-980-3082
Mailing Address - Fax:
Practice Address - Street 1:2901 COLTSGATE RD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4384
Practice Address - Country:US
Practice Address - Phone:704-980-3082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health