Active NPI
Marilyn Robertson, LAC
- Addiction (Substance Use Disorder) Counselor
- Dickinson, ND
National Provider Identifier
1366463911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 1407
- Practice address
- 300 13TH Ave W
Suite 1
Dickinson, ND 58601-4879 - Phone
- (701) 227-7503
- Fax
- (701) 227-7575
- NPI assigned
- Jul 21, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1407 | ND | Primary |
Addresses
Primary practice location
300 13TH Ave W
Suite 1
Dickinson, ND 58601-4879
Mailing address
300 13TH Ave W
Suite 1
Dickinson, ND 58601-4879
Phone (701) 227-7503
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54523 | Medicaid | ND | |
| 014079 | Other | ND | BCBS PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1407 | ND | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1230681600000",
"number": "1366463911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 13TH AVE W",
"address_2": "SUITE 1",
"city": "DICKINSON",
"state": "ND",
"postal_code": "586014879",
"telephone_number": "701-227-7503",
"fax_number": "701-227-7575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 13TH AVE W",
"address_2": "SUITE 1",
"city": "DICKINSON",
"state": "ND",
"postal_code": "586014879",
"telephone_number": "701-227-7503",
"fax_number": "701-227-7575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "MARILYN",
"name_prefix": "Ms.",
"credential": "LAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-21",
"last_updated": "2008-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "ND",
"license": "1407",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "54523",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PIN",
"identifier": "014079",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dickinson, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.