Healthcare Provider Details

I. General information

NPI: 1366548687
Provider Name (Legal Business Name): MARY ELIZABETH ROBINSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 REYNOLDA RD
WINSTON SALEM NC
27104-3245
US

IV. Provider business mailing address

1708 ELIZABETH AVE
WINSTON SALEM NC
27103-2712
US

V. Phone/Fax

Practice location:
  • Phone: 336-723-1011
  • Fax: 336-723-1411
Mailing address:
  • Phone: 336-777-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number927
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: