Healthcare Provider Details

I. General information

NPI: 1992733471
Provider Name (Legal Business Name): BETTY V ROBERTS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETTY V ROBERTS LPC

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N PATTERSON ST
VALDOSTA GA
31602-1735
US

IV. Provider business mailing address

1344 US HIGHWAY 19 S
LEESBURG GA
31763-4867
US

V. Phone/Fax

Practice location:
  • Phone: 229-259-4139
  • Fax: 229-259-4925
Mailing address:
  • Phone: 229-436-6004
  • Fax: 229-888-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number003634
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: