Provider Demographics
NPI:1043254527
Name:ROBERTS, MARILYN CATHERINE (MS LPC)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:CATHERINE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W LANIER AVE
Mailing Address - Street 2:SUITE 508
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7636
Mailing Address - Country:US
Mailing Address - Phone:678-817-6600
Mailing Address - Fax:678-817-6333
Practice Address - Street 1:500 W LANIER AVE
Practice Address - Street 2:SUITE 508
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7636
Practice Address - Country:US
Practice Address - Phone:678-817-6600
Practice Address - Fax:678-817-6333
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1399101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional