Provider Demographics
NPI:1669777652
Name:ROBERTSON, RICHETTA LYNN (BS)
Entity type:Individual
Prefix:MISS
First Name:RICHETTA
Middle Name:LYNN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-2004
Mailing Address - Country:US
Mailing Address - Phone:434-250-5477
Mailing Address - Fax:434-799-3282
Practice Address - Street 1:1225 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4709
Practice Address - Country:US
Practice Address - Phone:434-799-3280
Practice Address - Fax:434-799-3282
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional