MEDICARE: KIM L 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	LPC008144	GA
2	101YP2500X	Professional Counselor	LPC008144	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699172684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIM L ROBERTS

Provider Business Mailing Address
First Line	:	1801 BALDWIN FARMS DR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-1555
Country	:	US
Telephone Number	:	770-355-2381
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 JOHNSON FERRY RD STE 125
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-6403
Country	:	US
Telephone Number	:	770-703-9031
Fax Number	:	404-689-6679

Authorized Official
Title or Position	:	THERAPIST/COUNSELOR
Name	:	KIM LAND ROBERTS
Credential	:	LPC, CPCS
Telephone Number	:	770-355-2381

Provider Enumeration Date	:	11/19/2014
Last Update Date	:	03/23/2026

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