Individual
JACK A. ROBINSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
4650 E PRAIRIE LN, COTTONWOOD, AZ 86326-5970
(602) 717-8682
(928) 649-0270
Mailing address
4650 E PRAIRIE LN, COTTONWOOD, AZ 86326-5970
(602) 717-8682
(928) 649-0270
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC-11096
AZ
101YP2500X
Professional Counselor
Primary
LPC-11734
AZ
Other
Enumeration date
12/03/2011
Last updated
12/03/2011
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