Provider Demographics
NPI:1386240968
Name:ROBISON, COURTNEY KELLEY (LMSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KELLEY
Last Name:ROBISON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 REVERE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1418
Mailing Address - Country:US
Mailing Address - Phone:248-882-7299
Mailing Address - Fax:
Practice Address - Street 1:1810 REVERE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1418
Practice Address - Country:US
Practice Address - Phone:248-882-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011071691041C0700X
MI68011179551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI58326941Medicaid