Provider Demographics
NPI:1881124634
Name:ROBERTS, PATRICIA ANDERSON (LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANDERSON
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:LESLI
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:4821 COVE RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-5075
Mailing Address - Country:US
Mailing Address - Phone:770-893-9585
Mailing Address - Fax:
Practice Address - Street 1:137 PROMINENCE CT STE 220
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-8939
Practice Address - Country:US
Practice Address - Phone:706-725-8934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005272101YP2500X
GALPC010910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional