Healthcare Provider Details

I. General information

NPI: 1639704646
Provider Name (Legal Business Name): MR. TREVOR BRIAN ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 CAPRICORN WAY STE 207
SANTA ROSA CA
95407-5486
US

IV. Provider business mailing address

2227 CAPRICORN WAY STE 207
SANTA ROSA CA
95407-5486
US

V. Phone/Fax

Practice location:
  • Phone: 707-903-8907
  • Fax:
Mailing address:
  • Phone: 415-798-7716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: