Provider Demographics
NPI:1467797795
Name:BROOKE A. ROBILLARD, L.L.C.
Entity Type:Organization
Organization Name:BROOKE A. ROBILLARD, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RPT
Authorized Official - Phone:706-331-0207
Mailing Address - Street 1:480 FLINT HILL RD
Mailing Address - Street 2:
Mailing Address - City:ARAGON
Mailing Address - State:GA
Mailing Address - Zip Code:30104-2114
Mailing Address - Country:US
Mailing Address - Phone:706-331-0207
Mailing Address - Fax:
Practice Address - Street 1:5 LEON ST SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-4021
Practice Address - Country:US
Practice Address - Phone:706-232-6662
Practice Address - Fax:706-235-6230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0039921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty