Healthcare Provider Details

I. General information

NPI: 1487105524
Provider Name (Legal Business Name): ROBERT LEE ABERCROMBIE JR. MS. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10850 W PARK PL STE 100
MILWAUKEE WI
53224-3636
US

IV. Provider business mailing address

10850 W PARK PL STE 100
MILWAUKEE WI
53224-3636
US

V. Phone/Fax

Practice location:
  • Phone: 262-789-1191
  • Fax: 414-359-1021
Mailing address:
  • Phone: 262-789-1191
  • Fax: 414-359-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP5363
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8160-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: