MEDICARE: MELISSA GAYLE ROBERTS LPC-R

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	101Y00000X	Counselor	0704013146	VA

General Provider Information

NPI Number	:	1669123618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA GAYLE ROBERTS LPC-R

Provider Business Mailing Address
First Line	:	4233 SPRING RUN RD
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-6638
Country	:	US
Telephone Number	:	804-305-4872
Fax Number	:

Provider Business Practice Location Address
First Line	:	5230 HICKORY PARK DR STE A
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-2628
Country	:	US
Telephone Number	:	804-322-9955
Fax Number	:

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

Provider Enumeration Date	:	01/11/2022
Last Update Date	:	01/11/2022

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