Provider Demographics
NPI:1912653064
Name:ROBERTS, ALAN LEWIS
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:LEWIS
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LEINART ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-3630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:865-269-5924
Practice Address - Street 1:109 LEINART ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3630
Practice Address - Country:US
Practice Address - Phone:865-264-4455
Practice Address - Fax:865-269-5924
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000001233101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)