Provider Demographics
NPI:1518610369
Name:ROBERTSON, TOCCARA
Entity Type:Individual
Prefix:
First Name:TOCCARA
Middle Name:
Last Name:ROBERTSON
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 1:3049 CLOVER RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VA
Mailing Address - Zip Code:23962-3001
Mailing Address - Country:US
Mailing Address - Phone:434-222-5771
Mailing Address - Fax:
Practice Address - Street 1:3049 CLOVER RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VA
Practice Address - Zip Code:23962-3001
Practice Address - Country:US
Practice Address - Phone:434-222-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
VA4003251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health