Provider Demographics
NPI:1417568684
Name:ROBINSON, KIMBERLY ALEXIS (MSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALEXIS
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 OVERTON DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1748
Mailing Address - Country:US
Mailing Address - Phone:252-458-5166
Mailing Address - Fax:
Practice Address - Street 1:2747 SUNSET AVE STE 109
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3751
Practice Address - Country:US
Practice Address - Phone:252-985-3216
Practice Address - Fax:252-985-3210
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0147771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical