Provider Demographics
NPI:1366506099
Name:NEIL, ROBERT G (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:NEIL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0714
Mailing Address - Country:US
Mailing Address - Phone:912-764-7001
Mailing Address - Fax:912-489-6864
Practice Address - Street 1:326 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0714
Practice Address - Country:US
Practice Address - Phone:912-764-7001
Practice Address - Fax:912-489-6864
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA911465665AMedicaid