Doctor Name: | MRS. JEAN KOLLEN ROBERTSON |
NPI Number: | 1306141890 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH 10598 |
Business Practice Address: | 700 Seagate Ave Neptune Beach, FL - 322663505 |
Business Phone Number: | 9042708200 |
Business Fax Number: | |
Mailing Address: | 1916 Strickland Rd, NEPTUNE BEACH |
State: | FL |
Postal Code: | 322661535 |
Phone Number: | 9042521049 |
Fax Number: | |
NPI Enumeration Date: | 01/14/2011 |
NPI Last Update Date: | 01/14/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH 10598 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |