Provider Demographics
NPI:1871237016
Name:ROBERTS, ROBERT BOYD (ALC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BOYD
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 EAGLE POINT CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-1900
Mailing Address - Country:US
Mailing Address - Phone:205-240-5066
Mailing Address - Fax:205-314-5799
Practice Address - Street 1:4000 EAGLE POINT CORPORATE DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-1900
Practice Address - Country:US
Practice Address - Phone:205-240-5066
Practice Address - Fax:205-314-5700
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04100101Y00000X, 101YM0800X
ALC4100A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty