Provider Demographics
NPI:1518251495
Name:LOONEY, ROBIN L (LICDC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:LOONEY
Suffix:
Gender:F
Credentials:LICDC
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:SKAGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:178 PRIVATE ROAD 19423
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-8831
Mailing Address - Country:US
Mailing Address - Phone:740-263-2626
Mailing Address - Fax:
Practice Address - Street 1:178 PRIVATE ROAD 19423
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-8831
Practice Address - Country:US
Practice Address - Phone:740-263-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0023667101YA0400X
OH0023667104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)