Provider Demographics
NPI:1639888977
Name:ROBERTS, HEATHER MARONDA
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARONDA
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 1:625 MAGNOLIA GARDENS WALK
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6081
Mailing Address - Country:US
Mailing Address - Phone:678-357-2164
Mailing Address - Fax:
Practice Address - Street 1:625 MAGNOLIA GARDENS WALK
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6081
Practice Address - Country:US
Practice Address - Phone:678-357-2164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician