Provider Demographics
NPI:1962669689
Name:STURDIVANT, ROBERT MARK (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARK
Last Name:STURDIVANT
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 1:895 STATE FARM RD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4917
Mailing Address - Country:US
Mailing Address - Phone:828-263-5666
Mailing Address - Fax:828-262-5687
Practice Address - Street 1:1650 HWY 18 SOUTH
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-8478
Practice Address - Country:US
Practice Address - Phone:336-372-4095
Practice Address - Fax:828-262-5687
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional