Individual
GERVONIA ROBINSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1714 ASTER LN, GASTONIA, NC 28054-8303
(984) 221-1140
(803) 630-0376
Mailing address
13906 BALLANTYNE MEADOWS DR, CHARLOTTE, NC 28277-3727
(984) 221-1140
(803) 630-0376
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/16/2018
Last updated
12/16/2018
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