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General NPI Number Information
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NPI Number | 1477069243
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Entity Type | Organization
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Legal Business Name | ROBERTS COUNSELING CENTER LLC
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 900 CESERY BLVD STE 111
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City | JACKSONVILLE
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State | FL
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Zip | 32211-5634
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Country | US
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Telephone | 904-962-2826
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Fax | 904-962-2826
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Provider Business Mailing Address
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Address Line | 1995 WAGES WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32218-8057
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Country | US
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Telephone | 904-962-2826
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SONIA A ROBERTS
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Credential | LMHC
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Telephone | 904-962-2826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | MH13275
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MH13275
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License Number State | FL
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