Provider Demographics
NPI:1104350750
Name:PHELPS, ROBBIN
Entity type:Individual
Prefix:
First Name:ROBBIN
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7412 GEORGIA AVE NW
Mailing Address - Street 2:# 4
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1754
Mailing Address - Country:US
Mailing Address - Phone:202-288-9017
Mailing Address - Fax:
Practice Address - Street 1:7412 GEORGIA AVE NW
Practice Address - Street 2:# 4
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1754
Practice Address - Country:US
Practice Address - Phone:202-288-9017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50082008104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker