Provider Demographics
NPI:1649302605
Name:ROBB, CAROLINA
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:ROBB
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 1:2647 INTERNATIONAL BLVD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1537
Mailing Address - Country:US
Mailing Address - Phone:510-532-5242
Mailing Address - Fax:510-533-7918
Practice Address - Street 1:2647 INTERNATIONAL BLVD
Practice Address - Street 2:SUITE 412
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1537
Practice Address - Country:US
Practice Address - Phone:510-532-5242
Practice Address - Fax:510-533-7918
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM13514101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11486601OtherCAQH