Provider Demographics
NPI:1134534068
Name:ROBERTS, BRIAN MICHAEL (LPC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 COUNTRY GLEN CT
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-3949
Mailing Address - Country:US
Mailing Address - Phone:770-367-0851
Mailing Address - Fax:
Practice Address - Street 1:723 INDUSTRIAL PARK DR UNIT A
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4352
Practice Address - Country:US
Practice Address - Phone:706-504-4782
Practice Address - Fax:706-955-1412
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004405101YM0800X
GALPC010027101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health