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General NPI Number Information
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NPI Number | 1730337262
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Entity Type | Individual
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Provider Name | ROBIN LEE WOOLLEY LISW, LADAC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 615 E LINCOLN ST
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City | LAS VEGAS
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State | NM
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Zip | 87701-4502
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Country | US
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Telephone | 719-680-9680
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 162 201 RAILROAD AVE.
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City | WAGON MOUND
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State | NM
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Zip | 87752-0162
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Country | US
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Telephone | 719-680-9680
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0092671
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-2696
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-1129
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License Number State | AZ
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