Provider Demographics
NPI:1982211389
Name:ROBERTS, GEORGANNE
Entity Type:Individual
Prefix:
First Name:GEORGANNE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43335 K BEACH RD STE 36
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8280
Mailing Address - Country:US
Mailing Address - Phone:907-262-6331
Mailing Address - Fax:907-262-6294
Practice Address - Street 1:43335 K BEACH RD STE 36
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8280
Practice Address - Country:US
Practice Address - Phone:907-262-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health