Provider Demographics
NPI:1366750796
Name:ROBINSON, CRYSTAL GERVAIS (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:GERVAIS
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:REBECCA
Other - Last Name:GERVAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1106 SHILOH CIR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-8392
Mailing Address - Country:US
Mailing Address - Phone:864-455-4041
Mailing Address - Fax:864-455-8447
Practice Address - Street 1:1106 SHILOH CIR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-8392
Practice Address - Country:US
Practice Address - Phone:864-455-4041
Practice Address - Fax:864-455-8447
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC47133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered