Individual
DR. WOODROW ANTHONY ROEBACK III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPC, CRC, LPC
Contact information
Practice address
1103 48TH AVE N STE 201, MYRTLE BEACH, SC 29577-5418
(843) 501-1099
(843) 405-2040
Mailing address
1103 48TH AVE N STE 201, MYRTLE BEACH, SC 29577-5418
(843) 501-1099
(843) 405-2040
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
128746726004
UT
101YM0800X
Mental Health Counselor
CP0182
NV
101YP2500X
Professional Counselor
Primary
12362
SC
101YP2500X
Professional Counselor
9352
CA
302F00000X
Exclusive Provider Organization
NV20131237531
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15102754
CAQH
—
Enumeration date
03/01/2013
Last updated
07/23/2026
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