MEDICARE: SHANTON ROBERSON

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
2	1041C0700X	Clinical Social Worker		FL

General Provider Information

NPI Number	:	1740726355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTON ROBERSON

Provider Business Mailing Address
First Line	:	116 DEER SPRINGS RD SW
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35603-4933
Country	:	US
Telephone Number	:	904-729-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 DEER SPRINGS RD SW
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35603-4933
Country	:	US
Telephone Number	:	904-729-1611
Fax Number	:

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

Provider Enumeration Date	:	01/07/2017
Last Update Date	:	08/15/2023

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Directions to “ SHANTON ROBERSON ” Practice Location

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