Provider Demographics
NPI:1356897342
Name:ROBERTS, CREIGHTON (LPC)
Entity type:Individual
Prefix:
First Name:CREIGHTON
Middle Name:
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 1:100 MARINERS DR STE D
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6667
Mailing Address - Country:US
Mailing Address - Phone:912-510-0669
Mailing Address - Fax:912-510-0754
Practice Address - Street 1:100 MARINERS DR STE D
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6667
Practice Address - Country:US
Practice Address - Phone:912-510-0669
Practice Address - Fax:912-510-0754
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health