Healthcare Provider Details

I. General information

NPI: 1518460989
Provider Name (Legal Business Name): EVA ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 E 13 MILE RD
WARREN MI
48093-3093
US

IV. Provider business mailing address

12053 ROSEMONT AVE
DETROIT MI
48228-1150
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-1810
  • Fax:
Mailing address:
  • Phone: 313-670-4683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016562
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: