Provider Demographics
NPI:1215279047
Name:ROBINSON, ESTELLE LACOSTE (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:ESTELLE
Middle Name:LACOSTE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 E PASS RD
Mailing Address - Street 2:B
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3523
Mailing Address - Country:US
Mailing Address - Phone:228-563-3879
Mailing Address - Fax:
Practice Address - Street 1:1455 E PASS RD
Practice Address - Street 2:B
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3523
Practice Address - Country:US
Practice Address - Phone:228-563-3879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health