Provider Demographics
NPI:1609181965
Name:HARVELL, ROBERT L (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:HARVELL
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 1:1102 BOMBAY LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5832
Mailing Address - Country:US
Mailing Address - Phone:770-880-2090
Mailing Address - Fax:770-880-2090
Practice Address - Street 1:1090 ALLENBROOK LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2983
Practice Address - Country:US
Practice Address - Phone:770-880-2090
Practice Address - Fax:770-880-2090
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005345101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional