Provider Demographics
NPI:1487207965
Name:ROBERTS, CARLEY CHRISTINE
Entity Type:Individual
Prefix:
First Name:CARLEY
Middle Name:CHRISTINE
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 1:1840 20 MILE RD
Mailing Address - Street 2:
Mailing Address - City:KENT CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49330-9735
Mailing Address - Country:US
Mailing Address - Phone:616-430-5616
Mailing Address - Fax:
Practice Address - Street 1:130 W WOOD ST
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-8991
Practice Address - Country:US
Practice Address - Phone:231-206-6519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801113884104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker