Provider Demographics
NPI:1790297786
Name:ROBERSON, CHARLTON (CSAC)
Entity Type:Individual
Prefix:MR
First Name:CHARLTON
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 LAGUARDIA DR.
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348
Mailing Address - Country:US
Mailing Address - Phone:910-813-6866
Mailing Address - Fax:
Practice Address - Street 1:2149 VALLEYGATE DR STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3666
Practice Address - Country:US
Practice Address - Phone:910-745-8895
Practice Address - Fax:910-758-8254
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20878101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty