MEDICARE: MS. STEPHANIE NICOLE ROBERTSON LPC, LAC, AADC, MAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	100	SC
2	101YP2500X	Professional Counselor	6403	SC

General Provider Information

NPI Number	:	1265708820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE NICOLE ROBERTSON LPC, LAC, AADC, MAC

Provider Business Mailing Address
First Line	:	113 LEN CT
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-5526
Country	:	US
Telephone Number	:	864-371-0538
Fax Number	:

Provider Business Practice Location Address
First Line	:	364 S PINE ST STE A110
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-2654
Country	:	US
Telephone Number	:	864-515-6440
Fax Number	:	864-308-2442

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

Provider Enumeration Date	:	03/28/2012
Last Update Date	:	09/13/2023

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