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General NPI Number Information
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NPI Number | 1720058118
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Entity Type | Individual
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Provider Name | REGINA LEE ROBERTS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 2401 DUTCH VALLEY DR. SUITE 12
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City | KNOXVILLE
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State | TN
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Zip | 37918-1731
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Country | US
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Telephone | 865-281-8558
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Fax | 888-311-9599
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Provider Business Mailing Address
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Address Line | PO BOX 51946
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City | KNOXVILLE
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State | TN
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Zip | 37950-1946
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Country | US
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Telephone | 865-281-8558
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Fax | 888-311-9599
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LSW3113
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License Number State | TN
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