Provider Demographics
NPI:1073121323
Name:ROBERTS, CHALLINA (LGP)
Entity Type:Individual
Prefix:
First Name:CHALLINA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 23RD PKWY APT 908
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4462
Mailing Address - Country:US
Mailing Address - Phone:240-723-1067
Mailing Address - Fax:
Practice Address - Street 1:4550 FORBES BLVD STE 330
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6309
Practice Address - Country:US
Practice Address - Phone:301-609-9887
Practice Address - Fax:301-609-9091
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10186101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional