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General NPI Number Information
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NPI Number | 1982700019
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Entity Type | Individual
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Provider Name | ANDREW MARK ROBERTS PHD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 415 N EDGEWORTH ST SUITE 206
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City | GREENSBORO
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State | NC
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Zip | 27401-2182
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Country | US
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Telephone | 336-574-0404
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Fax | 336-545-5566
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Provider Business Mailing Address
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Address Line | 1203 QUAIL DR
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City | GREENSBORO
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State | NC
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Zip | 27408
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Country | US
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Telephone | 336-574-0404
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Fax | 336-545-5566
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0851
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License Number State | NC
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