Provider Demographics
NPI:1144516428
Name:ROBIN FENLON LMSW PC
Entity type:Organization
Organization Name:ROBIN FENLON LMSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LUCINDA
Authorized Official - Last Name:FENLON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LMSW,ACSW,CAADC
Authorized Official - Phone:810-919-9722
Mailing Address - Street 1:740 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1134
Mailing Address - Country:US
Mailing Address - Phone:810-686-7313
Mailing Address - Fax:810-686-7315
Practice Address - Street 1:740 CENTER ST
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1134
Practice Address - Country:US
Practice Address - Phone:810-686-7313
Practice Address - Fax:810-686-7315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801067778101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty