Provider Demographics
NPI:1568908101
Name:EMERALD ISLE COUNSELING
Entity Type:Organization
Organization Name:EMERALD ISLE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBB
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC, MED
Authorized Official - Phone:912-268-4750
Mailing Address - Street 1:302 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-1346
Mailing Address - Country:US
Mailing Address - Phone:912-268-4750
Mailing Address - Fax:
Practice Address - Street 1:300 OAK ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-4738
Practice Address - Country:US
Practice Address - Phone:912-268-4750
Practice Address - Fax:888-837-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003181251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1730402207OtherINDIVDULE NPI