Basic Information
| Provider Information | |||||||||
| NPI: | 1922501998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | ALBERT | ||||||||
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| Credential: | CDPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 E FOURTH PLAIN BLVD BLDG 17 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986613717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603978488 | ||||||||
| FaxNumber: | 3603978492 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 E FOURTH PLAIN BLVD BLDG 17B222 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986613713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603978488 | ||||||||
| FaxNumber: | 3603978492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2018 | ||||||||
| LastUpdateDate: | 01/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CO60881922 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.