Healthcare Provider Details

I. General information

NPI: 1285962696
Provider Name (Legal Business Name): CHRISTOPHER ROBERTSON M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W MARKET ST UNCG PSYCHOLOGY CLINIC
GREENSBORO NC
27403-1830
US

IV. Provider business mailing address

PO BOX 26170 UNCG PSYCHOLOGY CLINIC
GREENSBORO NC
27402-6170
US

V. Phone/Fax

Practice location:
  • Phone: 336-334-5662
  • Fax: 336-334-5754
Mailing address:
  • Phone: 336-334-5662
  • Fax: 336-334-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3840
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: