Healthcare Provider Details

I. General information

NPI: 1396312666
Provider Name (Legal Business Name): ALEXANDER RYAN ROBERTS MED, LAPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. ALEX ROBERTS

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 CLAIRMONT RD NE STE B
BROOKHAVEN GA
30329-1043
US

IV. Provider business mailing address

879 N POINT DR APT B
AKRON OH
44313-8706
US

V. Phone/Fax

Practice location:
  • Phone: 404-636-1457
  • Fax:
Mailing address:
  • Phone: 419-617-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: