Provider Demographics
NPI:1659902393
Name:ROBERSON, OTIS LAMONTE II (LCSW-A)
Entity Type:Individual
Prefix:MR
First Name:OTIS
Middle Name:LAMONTE
Last Name:ROBERSON
Suffix:II
Gender:M
Credentials:LCSW-A
Other - Prefix:MR
Other - First Name:OTIS
Other - Middle Name:LAMONTE
Other - Last Name:ROBERSON
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2008 S MEBANE ST APT E
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-7614
Mailing Address - Country:US
Mailing Address - Phone:704-352-1939
Mailing Address - Fax:844-272-1223
Practice Address - Street 1:2008 S MEBANE ST APT E
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-7614
Practice Address - Country:US
Practice Address - Phone:704-352-1939
Practice Address - Fax:844-272-1223
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0142681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical