Provider Demographics
NPI:1811205339
Name:ROBERTSON, JOANNE GALLO (LPC)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:GALLO
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 S. DELSEA DRIVE
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028
Mailing Address - Country:US
Mailing Address - Phone:856-881-8689
Mailing Address - Fax:856-881-7614
Practice Address - Street 1:220 RONNIE CT COASTAL HAVEN COUNSELING
Practice Address - Street 2:SUITE 2
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579
Practice Address - Country:US
Practice Address - Phone:943-945-0346
Practice Address - Fax:856-881-7614
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00383000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional