Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | IMH8824 | FL |
NPI | 1003169194 |
---|---|
Provider Name | Dustin Robbins |
First Address | Temple Terrace, FL 33617-1259 |
Second Address | Temple Terrace, FL 33617-1259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2012 |
Last Update Date | 26/10/2012 |