Healthcare Provider Details

I. General information

NPI: 1699172684
Provider Name (Legal Business Name): KIM L ROBERTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 JOHNSON FERRY RD STE 125
MARIETTA GA
30062-6403
US

IV. Provider business mailing address

1801 BALDWIN FARMS DR
MARIETTA GA
30068-1555
US

V. Phone/Fax

Practice location:
  • Phone: 770-703-9031
  • Fax: 404-689-6679
Mailing address:
  • Phone: 770-355-2381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC008144
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008144
License Number StateGA

VIII. Authorized Official

Name: KIM LAND ROBERTS
Title or Position: THERAPIST/COUNSELOR
Credential: LPC, CPCS
Phone: 770-355-2381