Healthcare Provider Details

I. General information

NPI: 1083950737
Provider Name (Legal Business Name): ERIN M MCGOWAN-ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 ALPINE BLVD STE A
ALPINE CA
91901-1101
US

IV. Provider business mailing address

2271 ALPINE BLVD STE A
ALPINE CA
91901-1101
US

V. Phone/Fax

Practice location:
  • Phone: 619-448-1216
  • Fax:
Mailing address:
  • Phone: 619-540-7755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number112847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: