Provider Demographics
NPI:1306683461
Name:ROBINSON, DEMI SHANTEL
Entity type:Individual
Prefix:
First Name:DEMI
Middle Name:SHANTEL
Last Name:ROBINSON
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 1:15801 BRIXHAM HILL AVE STE 475
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0878
Mailing Address - Country:US
Mailing Address - Phone:704-251-9084
Mailing Address - Fax:704-513-7720
Practice Address - Street 1:15801 BRIXHAM HILL AVE STE 475
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0878
Practice Address - Country:US
Practice Address - Phone:704-251-9084
Practice Address - Fax:704-513-7720
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103616103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical