Basic Information
| Provider Information | |||||||||
| NPI: | 1649598319 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALEKE | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | BENSON | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 KORNEGAY RD | ||||||||
| Address2: | |||||||||
| City: | BATESVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386067259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6626091899 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2173 S LAMAR BLVD | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386555223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622346553 | ||||||||
| FaxNumber: | 6622346556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2010 | ||||||||
| LastUpdateDate: | 05/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C5591 | MS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.