Provider Demographics
NPI:1518122811
Name:ROBILLARD, BROOKE (LCSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:ROBILLARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALCSW0039921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical