Provider Demographics
NPI:1841521911
Name:ROBINSON, RANDY (MSW, LCAS, CSI, MAC)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MSW, LCAS, CSI, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 W CLUB BLVD
Mailing Address - Street 2:SUITE 616
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1104
Mailing Address - Country:US
Mailing Address - Phone:984-219-7056
Mailing Address - Fax:984-219-7056
Practice Address - Street 1:1058 W CLUB BLVD
Practice Address - Street 2:SUITE 616
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-1104
Practice Address - Country:US
Practice Address - Phone:984-219-7056
Practice Address - Fax:984-219-7056
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1313101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112124Medicaid