Basic Information
| Provider Information | |||||||||
| NPI: | 1558679050 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COUNTS ROBINSON | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | PHD, PMHNP-BC,ANP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 139 EASTWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | SWANNANOA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287782607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286919757 | ||||||||
| FaxNumber: | 8286522981 | ||||||||
| Practice Location | |||||||||
| Address1: | 1881 WORCESTER RD | ||||||||
| Address2: | |||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017015410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086286300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2010 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 1431 | NC | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 363LA2200X | 5004871 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LP0808X | 5004871 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 7004654 | 05 | NC | MEDICAID |