1245285626 NPI number — MR. GREGORY HOWARD ROBINSON MAMFC MARE LPC

Table of content: MR. GREGORY HOWARD ROBINSON MAMFC MARE LPC (NPI 1245285626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245285626 NPI number — MR. GREGORY HOWARD ROBINSON MAMFC MARE LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
GREGORY
Provider Middle Name:
HOWARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MAMFC MARE LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245285626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 SILVER BRANCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-957-7338
Provider Business Mailing Address Fax Number:
803-939-9086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2999 SUNSET BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-939-9699
Provider Business Practice Location Address Fax Number:
803-939-9086
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  3936 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5729 . This is a "PALMETTO HEALTH BAPTIST" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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