Provider Demographics
NPI:1023470150
Name:ROBERTS, WILLIAM CARLETON II (LICDC-CS)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CARLETON
Last Name:ROBERTS
Suffix:II
Gender:M
Credentials:LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3567 WALES DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-1844
Mailing Address - Country:US
Mailing Address - Phone:937-718-7271
Mailing Address - Fax:
Practice Address - Street 1:3567 WALES DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1844
Practice Address - Country:US
Practice Address - Phone:937-718-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH943727101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)