MEDICARE: NADINE ROBERTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	12126	NC

General Provider Information

NPI Number	:	1205056454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADINE ROBERTS

Provider Business Mailing Address
First Line	:	9625 DAVID TAYLOR DR STE 120A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-2362
Country	:	US
Telephone Number	:	704-277-0001
Fax Number	:	980-833-1048

Provider Business Practice Location Address
First Line	:	9625 DAVID TAYLOR DR STE 120A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-2362
Country	:	US
Telephone Number	:	704-277-0001
Fax Number	:	980-833-1048

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	09/09/2021

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Directions to “ NADINE ROBERTS ” Practice Location

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