Provider Demographics
NPI:1508380189
Name:ROBERTS, JAMIE COLLEEN (LCSWA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:COLLEEN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:WARREN-WARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:137 PINE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28457-8997
Mailing Address - Country:US
Mailing Address - Phone:910-978-0618
Mailing Address - Fax:
Practice Address - Street 1:5013 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7045
Practice Address - Country:US
Practice Address - Phone:191-079-6686
Practice Address - Fax:910-796-6868
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO116341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical