Provider Demographics
NPI:1063705846
Name:ROBIN D BREEDEN LCSW PLC
Entity type:Organization
Organization Name:ROBIN D BREEDEN LCSW PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BREEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-896-7687
Mailing Address - Street 1:133 W SPRINGBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815-9527
Mailing Address - Country:US
Mailing Address - Phone:540-896-7687
Mailing Address - Fax:540-896-7687
Practice Address - Street 1:133 W SPRINGBROOK RD
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815-9527
Practice Address - Country:US
Practice Address - Phone:540-896-7687
Practice Address - Fax:540-896-7687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904005919174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1245294859OtherNPI