Provider Demographics
NPI:1952154106
Name:ROBINSON-YOUNG, BONCILE
Entity Type:Individual
Prefix:
First Name:BONCILE
Middle Name:
Last Name:ROBINSON-YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BONCILE
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1975 W GRAND ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-3458
Mailing Address - Country:US
Mailing Address - Phone:313-484-7244
Mailing Address - Fax:
Practice Address - Street 1:15560 JOY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-8200
Practice Address - Country:US
Practice Address - Phone:248-467-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator