Provider Demographics
NPI:1962676684
Name:ROBERTS, CAROL LOUISE (RAS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LOUISE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-6933
Mailing Address - Country:US
Mailing Address - Phone:707-643-2715
Mailing Address - Fax:707-643-8536
Practice Address - Street 1:419 PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-6933
Practice Address - Country:US
Practice Address - Phone:707-643-2715
Practice Address - Fax:707-643-8536
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)