Provider Demographics
NPI:1003982752
Name:ROBERSON, LEANETTE S (MA LPC)
Entity Type:Individual
Prefix:
First Name:LEANETTE
Middle Name:S
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 MALLARD LANE
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793
Mailing Address - Country:US
Mailing Address - Phone:229-386-2976
Mailing Address - Fax:
Practice Address - Street 1:1603 MALLARD LANE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793
Practice Address - Country:US
Practice Address - Phone:229-386-2976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003870101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor