Provider Demographics
NPI:1083181218
Name:ROBINSON, CAMILLE (ASUDC)
Entity type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:ASUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E 13200 S
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9078
Mailing Address - Country:US
Mailing Address - Phone:385-255-9117
Mailing Address - Fax:
Practice Address - Street 1:1601 E 13200 S
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9078
Practice Address - Country:US
Practice Address - Phone:385-255-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT286221-6008101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)