Provider Demographics
NPI:1093326142
Name:ROBERSON, WAKESHIA LATOYA
Entity Type:Individual
Prefix:
First Name:WAKESHIA
Middle Name:LATOYA
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WAKESHIA
Other - Middle Name:LATOYA
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:401 BOMBAY LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5826
Mailing Address - Country:US
Mailing Address - Phone:404-414-8676
Mailing Address - Fax:888-251-5653
Practice Address - Street 1:85 RISTONA DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-6220
Practice Address - Country:US
Practice Address - Phone:912-328-9722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0060791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical