Provider Demographics
NPI:1184861239
Name:ROBERTSON, SERENA JANELLE (MA)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:JANELLE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 PARK GLEN DR APT 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1060
Mailing Address - Country:US
Mailing Address - Phone:919-749-2918
Mailing Address - Fax:
Practice Address - Street 1:1310 PARK GLEN DR APT 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1060
Practice Address - Country:US
Practice Address - Phone:919-749-2918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health