MEDICARE: KRISTIN ROBERTS LPC

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	101YP2500X	Professional Counselor	011645	GA

General Provider Information

NPI Number	:	1871191213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN ROBERTS LPC

Provider Business Mailing Address
First Line	:	2522 SPARROW CT
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-5006
Country	:	US
Telephone Number	:	706-718-8146
Fax Number	:

Provider Business Practice Location Address
First Line	:	2522 SPARROW CT
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-5006
Country	:	US
Telephone Number	:	706-718-8146
Fax Number	:

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

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	10/16/2020

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