Healthcare Provider Details

I. General information

NPI: 1144516428
Provider Name (Legal Business Name): ROBIN FENLON LMSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 CENTER ST
CLIO MI
48420-1134
US

IV. Provider business mailing address

740 CENTER ST
CLIO MI
48420-1134
US

V. Phone/Fax

Practice location:
  • Phone: 810-686-7313
  • Fax: 810-686-7315
Mailing address:
  • Phone: 810-686-7313
  • Fax: 810-686-7315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6801067778
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801067778
License Number StateMI

VIII. Authorized Official

Name: MRS. ROBIN LUCINDA FENLON
Title or Position: OWNER
Credential: MSW,LMSW,ACSW,CAADC
Phone: 810-919-9722