MEDICARE: CARRIE ELIZABETH ROBERSON LMFT

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	106H00000X	Marriage & Family Therapist	1447	NC

General Provider Information

NPI Number	:	1871859108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE ELIZABETH ROBERSON LMFT

Provider Business Mailing Address
First Line	:	8400 SIX FORKS RD
Second Line	:	SUITE 203
City	:	RALEIGH
State	:	NC
Zip	:	27615-3068
Country	:	US
Telephone Number	:	910-515-6555
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 SIX FORKS RD
Second Line	:	SUITE 203
City	:	RALEIGH
State	:	NC
Zip	:	27615-3068
Country	:	US
Telephone Number	:	910-515-6555
Fax Number	:

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

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	07/18/2012

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