Provider Demographics
NPI:1932434156
Name:MASSENA, ROBERT DON JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DON
Last Name:MASSENA
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:MASSENA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1318 RAEFORD RD
Mailing Address - Street 2:STE 1
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5482
Mailing Address - Country:US
Mailing Address - Phone:910-813-1201
Mailing Address - Fax:910-485-6572
Practice Address - Street 1:1318 RAEFORD RD
Practice Address - Street 2:STE 1
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5482
Practice Address - Country:US
Practice Address - Phone:910-813-1201
Practice Address - Fax:910-485-6572
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional