Healthcare Provider Details

I. General information

NPI: 1689777989
Provider Name (Legal Business Name): ROBIN L. TARBOX-ROLAND L.M.F.T. 28766
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SPRING ST SUITE 306
LA MESA CA
91941-5263
US

IV. Provider business mailing address

4700 SPRING ST SUITE 306
LA MESA CA
91941
US

V. Phone/Fax

Practice location:
  • Phone: 619-709-7208
  • Fax: 619-469-4515
Mailing address:
  • Phone: 619-709-7208
  • Fax: 619-469-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT 28766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: