Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LC2579 | MD |
NPI | 1003131897 |
---|---|
Provider Name | Mr. Robert Daniel Robinson |
First Address | Ellicott City, MD 21042-7728 |
Second Address | Ellicott City, MD 21042-7728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2010 |
Last Update Date | 05/04/2010 |