Provider Demographics
NPI:1497870588
Name:ROBERSON, CHANDRA LEE (MC, LPC)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:LEE
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8188 SO. HIGHLAND DRIVE
Mailing Address - Street 2:SUITE D-4
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093
Mailing Address - Country:US
Mailing Address - Phone:801-918-8457
Mailing Address - Fax:
Practice Address - Street 1:8188 SO. HIGHLAND DRIVE
Practice Address - Street 2:SUITE D-4
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093
Practice Address - Country:US
Practice Address - Phone:801-918-8457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53350606009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional