Provider Demographics
NPI:1740664192
Name:BLACKWELL, ROBIN NEWBY
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:NEWBY
Last Name:BLACKWELL
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 1:509 FERNWAY DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-8850
Mailing Address - Country:US
Mailing Address - Phone:336-270-4463
Mailing Address - Fax:336-897-7564
Practice Address - Street 1:509 FERNWAY DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-8850
Practice Address - Country:US
Practice Address - Phone:336-270-4463
Practice Address - Fax:336-897-7564
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL001184251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health