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General NPI Number Information
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NPI Number | 1427448836
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Entity Type | Individual
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Provider Name | FAMIKA LASHELL ROBERTSON PH.D, SAE/SAP,
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Gender | Female
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 12/24/2024
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Provider Practice Location Address
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Address Line | 4901 OLDE TOWNE PKWY STE 165
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City | MARIETTA
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State | GA
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Zip | 30068-5645
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Country | US
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Telephone | 833-227-2489
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Fax | 770-415-7200
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Provider Business Mailing Address
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Address Line | 4901 OLDE TOWNE PKWY STE 165
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City | MARIETTA
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State | GA
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Zip | 30068-5645
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Country | US
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Telephone | 833-227-2489
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Fax | 707-415-7200
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710102892
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0732008394
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 802342
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License Number State | GA
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