Provider Demographics
NPI:1417163858
Name:SKALLEBERG, ROBERT (LPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:SKALLEBERG
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 1:5700 W GRACE ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1832
Mailing Address - Country:US
Mailing Address - Phone:804-282-1961
Mailing Address - Fax:804-288-2616
Practice Address - Street 1:5700 W GRACE ST
Practice Address - Street 2:SUITE 108
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1832
Practice Address - Country:US
Practice Address - Phone:804-282-1961
Practice Address - Fax:804-288-2616
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003572101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional