Provider Demographics
NPI:1548030364
Name:ROBERTSON, RODNEY BRYAN (BA, MDIV, MA, DMIN)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:BRYAN
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:BA, MDIV, MA, DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3643
Mailing Address - Country:US
Mailing Address - Phone:615-491-5985
Mailing Address - Fax:
Practice Address - Street 1:103 LYDIA ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-1240
Practice Address - Country:US
Practice Address - Phone:864-659-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC871101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)