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General NPI Number Information
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NPI Number | 1417759515
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Entity Type | Individual
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Provider Name | SUSAN ELLEN ROBERTS ATR
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Gender | Female
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 100 BREWSTER BLVD
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2575
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Country | US
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Telephone | 910-449-2833
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Fax |
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Provider Business Mailing Address
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Address Line | 2182 NEW RIVER INLET RD UNIT 280
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City | N TOPSAIL BEACH
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State | NC
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Zip | 28460-9315
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Country | US
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Telephone | 919-482-4620
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 07-115
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License Number State |
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