MEDICARE: KIM LAND ROBERTS LPC

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	LPC008144	GA
2	101YM0800X	Mental Health Counselor	TPMC2681	FL
3	101YP2500X	Professional Counselor	LPC008144	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891168373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM LAND ROBERTS LPC

Provider Business Mailing Address
First Line	:	1801 BALDWIN FARMS DR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-1555
Country	:	US
Telephone Number	:	770-355-2381
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 JOHNSON FERRY RD STE 125
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-6403
Country	:	US
Telephone Number	:	770-703-9031
Fax Number	:	904-337-0329

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

Provider Enumeration Date	:	11/05/2015
Last Update Date	:	10/18/2023

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Directions to “ KIM LAND ROBERTS LPC” Practice Location

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