Provider Demographics
NPI:1881566511
Name:TERRELL, ROBIN RENEE
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:RENEE
Last Name:TERRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23800 NORTHWESTERN HWY STE 190L
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7740
Mailing Address - Country:US
Mailing Address - Phone:734-934-1322
Mailing Address - Fax:
Practice Address - Street 1:23800 NORTHWESTERN HWY STE 190L
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7740
Practice Address - Country:US
Practice Address - Phone:734-934-1322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty