MEDICARE: CAROL CHRISTINE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0000867	CO
2	101YP2500X	Professional Counselor	LPC.0013305	CO

General Provider Information

NPI Number	:	1346676137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL CHRISTINE ROBERTS

Provider Business Mailing Address
First Line	:	2864 S BAHAMA ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80013-2310
Country	:	US
Telephone Number	:	720-253-4622
Fax Number	:

Provider Business Practice Location Address
First Line	:	6105 S MAIN ST STE 200
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-5361
Country	:	US
Telephone Number	:	720-432-2714
Fax Number	:

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

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	04/11/2018

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