Provider Demographics
NPI:1801339874
Name:ROBERTS, GREGORY JR (NCC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:ROBERTS
Suffix:JR
Gender:M
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 BARNSTABLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:240-381-5127
Mailing Address - Fax:
Practice Address - Street 1:2201 BARNSTABLE DRIVE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774
Practice Address - Country:US
Practice Address - Phone:240-381-5127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional