Provider Demographics
NPI:1285256768
Name:LEROY, ROBYN MELINDA
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:MELINDA
Last Name:LEROY
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:PO BOX 942
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23439-0942
Mailing Address - Country:US
Mailing Address - Phone:757-516-3700
Mailing Address - Fax:757-304-7739
Practice Address - Street 1:5809 MINERAL SPRING RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23438-9462
Practice Address - Country:US
Practice Address - Phone:757-516-3700
Practice Address - Fax:757-304-7739
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704010652101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health