Provider Demographics
NPI:1356729693
Name:ROBERTS, KATHERINE KRISTIAN (LISW-CP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KRISTIAN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 E MAIN ST APT 332
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3689
Mailing Address - Country:US
Mailing Address - Phone:803-528-8488
Mailing Address - Fax:
Practice Address - Street 1:518 E MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3668
Practice Address - Country:US
Practice Address - Phone:803-528-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC96501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical