MEDICARE: DR. FAMIKA LASHELL ROBERTSON PH.D, SAE/SAP,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0710102892	VA
2	101YM0800X	Mental Health Counselor	0732008394	VA
3	103TA0400X	Addiction (Substance Use Disorder) Psychologist	802342	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4567	OTHER	GA	NRC SUBSTANCE ABUSE EXPERT
2	CSAC-13850	OTHER	NC	CERTIFIED SUBSTANCE ABUSE COUNSELOR
3	NAMS1	OTHER	GA	NATIONAL ANGER MANAGEMENT SPECIALIST
4	4567	OTHER	GA	CISD TRAUMA SPECIALIST
5	20618	OTHER	GA	DOT-SUBSTANCE ABUSE PROFESSIONAL
6	ICADC-802342	OTHER	NC	IC/RC ALCOHOL DRUG COUNSELOR
7	0732008394	OTHER	VA	QUALIFIED MENTAL HEALTH PROFESSIONAL
8	3058-R	OTHER	GA	CAC-II GEORGIA
9	CSAC-0710102892	OTHER	VA	CERTIFIED SUBSTANCE ABUSE COUNSELOR
10	CERT 683	OTHER	GA	LIFE COACH

General Provider Information

NPI Number	:	1427448836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAMIKA LASHELL ROBERTSON PH.D, SAE/SAP,

Provider Business Mailing Address
First Line	:	4901 OLDE TOWNE PKWY STE 165
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-5645
Country	:	US
Telephone Number	:	833-227-2489
Fax Number	:	707-415-7200

Provider Business Practice Location Address
First Line	:	4901 OLDE TOWNE PKWY STE 165
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-5645
Country	:	US
Telephone Number	:	833-227-2489
Fax Number	:	770-415-7200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	12/24/2024

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