Provider Demographics
NPI:1073250395
Name:ROBERTS, AMY MICHELLE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 KING SPRINGS RD APT 606
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-9606
Mailing Address - Country:US
Mailing Address - Phone:423-946-4938
Mailing Address - Fax:
Practice Address - Street 1:1211 KING SPRINGS RD APT 606
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-9606
Practice Address - Country:US
Practice Address - Phone:423-946-4938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13754101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health