Provider Demographics
NPI:1740728872
Name:ROBERTSON, CORONDELETTE
Entity type:Individual
Prefix:
First Name:CORONDELETTE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2156 WOODDALE BLVD
Mailing Address - Street 2:STE. 100
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1403
Mailing Address - Country:US
Mailing Address - Phone:225-928-4040
Mailing Address - Fax:225-928-4111
Practice Address - Street 1:2156 WOODDALE BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1403
Practice Address - Country:US
Practice Address - Phone:225-928-4040
Practice Address - Fax:225-928-4111
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health