Provider Demographics
NPI:1659499549
Name:ROBERTS, DORIS PARKER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:PARKER
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1531
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30077-1531
Mailing Address - Country:US
Mailing Address - Phone:770-521-0444
Mailing Address - Fax:678-566-0405
Practice Address - Street 1:11205 ALPHARETTA HWY STE A6
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1442
Practice Address - Country:US
Practice Address - Phone:770-521-0444
Practice Address - Fax:678-566-0405
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0008881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical