Provider Demographics
NPI:1710655105
Name:ROBERTS, CHARMION (LAPC, NCC)
Entity Type:Individual
Prefix:
First Name:CHARMION
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 HIGHWAY 278 NE STE D
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2608
Mailing Address - Country:US
Mailing Address - Phone:478-308-4511
Mailing Address - Fax:
Practice Address - Street 1:5109 HIGHWAY 278 NE STE D
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2608
Practice Address - Country:US
Practice Address - Phone:478-308-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional