Healthcare Provider Details

I. General information

NPI: 1184047268
Provider Name (Legal Business Name): DR. CLYDE ROBINETTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W MARKET ST 3RD FLOOR
GREENSBORO NC
27403-1830
US

IV. Provider business mailing address

PO BOX 26170
GREENSBORO NC
27402-6170
US

V. Phone/Fax

Practice location:
  • Phone: 336-334-5662
  • Fax: 336-334-5754
Mailing address:
  • Phone: 336-334-5662
  • Fax: 336-334-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4494
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: