Provider Demographics
NPI:1275744005
Name:ROBERTS, KRISTIE PEARCE (MDIV)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:PEARCE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PARK PL
Mailing Address - Street 2:APT. 356P
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1567
Mailing Address - Country:US
Mailing Address - Phone:662-255-2809
Mailing Address - Fax:
Practice Address - Street 1:116 N 40TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-6605
Practice Address - Country:US
Practice Address - Phone:601-271-7589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional