Healthcare Provider Details

I. General information

NPI: 1578079190
Provider Name (Legal Business Name): QUIANA S ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 A ST SE APT E309
AUBURN WA
98002-6691
US

IV. Provider business mailing address

1902 A ST SE APT E309
AUBURN WA
98002-6691
US

V. Phone/Fax

Practice location:
  • Phone: 704-891-4355
  • Fax:
Mailing address:
  • Phone: 704-891-4355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMC60857502
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: