Provider Demographics
NPI:1255004925
Name:ROBERSON, ALEXIS MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E CEDAR HILL LN
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3738
Mailing Address - Country:US
Mailing Address - Phone:412-979-2554
Mailing Address - Fax:
Practice Address - Street 1:216 E CEDAR HILL LN
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-3738
Practice Address - Country:US
Practice Address - Phone:412-979-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11386101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health