Provider Demographics
NPI:1588944706
Name:ALLEN, ROBERT SHEPHERD (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SHEPHERD
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1794 SPINNAKER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-6828
Mailing Address - Country:US
Mailing Address - Phone:843-902-6943
Mailing Address - Fax:
Practice Address - Street 1:801 11TH AVE N
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-2644
Practice Address - Country:US
Practice Address - Phone:843-902-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional