Basic Information
| Provider Information | |||||||||
| NPI: | 1477762367 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 EASTERN AVE SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495073632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169883433 | ||||||||
| FaxNumber: | 6162330672 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 EASTERN AVE SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495073632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169883433 | ||||||||
| FaxNumber: | 3138997087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 04/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401009578 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.