Provider Demographics
NPI:1588895809
Name:ROBINSON, CONNIE L (MPA, LICDC)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MPA, LICDC
Other - Prefix:PROF
Other - First Name:CONNIE
Other - Middle Name:L
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1277 HEREFORD RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1343
Mailing Address - Country:US
Mailing Address - Phone:216-392-1005
Mailing Address - Fax:216-445-5747
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-4836
Practice Address - Fax:216-445-5747
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH965657101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)