Provider Demographics
NPI:1023446820
Name:ROBERTSON, BARBARA (MA, LPC, LBSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MA, LPC, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 HOWE CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-2785
Mailing Address - Country:US
Mailing Address - Phone:248-623-6738
Mailing Address - Fax:
Practice Address - Street 1:3201 HOWE CT
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-2785
Practice Address - Country:US
Practice Address - Phone:248-623-6738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003295101YP2500X
MI6802035860104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker