Provider Demographics
NPI:1497159685
Name:ROBERTSON, LEESA (MED, NCC, CAP, LPC)
Entity Type:Individual
Prefix:MS
First Name:LEESA
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MED, NCC, CAP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12430 STEVENS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-7445
Mailing Address - Country:US
Mailing Address - Phone:407-921-9067
Mailing Address - Fax:
Practice Address - Street 1:6740 JAMESTOWN DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3030
Practice Address - Country:US
Practice Address - Phone:678-799-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP2463101YA0400X
FLMH7146101YM0800X
GALPC0026575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health