Provider Demographics
NPI:1891073938
Name:EGAN, ROBERT JAMES (LAPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:EGAN
Suffix:
Gender:M
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COASTAL VILLAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-1974
Mailing Address - Country:US
Mailing Address - Phone:912-554-8510
Mailing Address - Fax:912-264-5965
Practice Address - Street 1:415 BONAVENTURE RD
Practice Address - Street 2:
Practice Address - City:THUNDERBOLT
Practice Address - State:GA
Practice Address - Zip Code:31404-3299
Practice Address - Country:US
Practice Address - Phone:912-790-6527
Practice Address - Fax:912-644-7729
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional