MEDICARE: MR. JAMES MELVILE ROBERTS LCASA

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	2919A	NC

General Provider Information

NPI Number	:	1841544103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES MELVILE ROBERTS LCASA

Provider Business Mailing Address
First Line	:	2537 CROSS POINT CIR APT 34
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-8354
Country	:	US
Telephone Number	:	704-299-6713
Fax Number	:	704-405-4262

Provider Business Practice Location Address
First Line	:	2537 CROSS POINT CIR APT 34
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-8354
Country	:	US
Telephone Number	:	704-299-6713
Fax Number	:	704-405-4262

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

Provider Enumeration Date	:	11/07/2012
Last Update Date	:	11/07/2012

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