Healthcare Provider Details

I. General information

NPI: 1437494374
Provider Name (Legal Business Name): LISA ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 ADELL REE PARK LN
KNOXVILLE TN
37909-2543
US

IV. Provider business mailing address

1700 PINEBROOK DR STE 4
KINGSPORT TN
37660-4365
US

V. Phone/Fax

Practice location:
  • Phone: 865-769-2600
  • Fax: 865-769-2616
Mailing address:
  • Phone: 423-251-6670
  • Fax: 423-251-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1758
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: