Healthcare Provider Details

I. General information

NPI: 1689637969
Provider Name (Legal Business Name): GEORGIA S. ROBERTSON L.P.C., L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CONNECTICUT AVE NW SUITE 306
WASHINGTON DC
20008-2509
US

IV. Provider business mailing address

6617 10TH ST B-1
ALEXANDRIA VA
22307-6617
US

V. Phone/Fax

Practice location:
  • Phone: 571-332-9648
  • Fax:
Mailing address:
  • Phone: 703-768-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC13851
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: