Healthcare Provider Details

I. General information

NPI: 1922921816
Provider Name (Legal Business Name): CHARLOTTE ELIZABETH ROBERTS LPC, MED, NCC, FCT 1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLOTTE ELIZABETH GLOVER LPC

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SAVANNAH AVENUE
STATESBORO GA
30458
US

IV. Provider business mailing address

131 VERANDA LN
STATESBORO GA
30458-7752
US

V. Phone/Fax

Practice location:
  • Phone: 706-506-7053
  • Fax: 912-225-3331
Mailing address:
  • Phone: 706-506-7053
  • Fax: 912-225-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC017094
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: