=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134200751
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. WORTHY L ROBBINS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 N. LAFAYETTE DR.
-----------------------------------------------------
City | SUMTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29151-1946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-418-5250
-----------------------------------------------------
Fax | 803-775-7593
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 N. MAGNOLIA ST.
-----------------------------------------------------
City | SUMTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29151-1946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-775-9364
-----------------------------------------------------
Fax | 803-773-6615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------