MEDICARE: EVELYN NICOLE ROBERTS LCSW

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	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1902264294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN NICOLE ROBERTS LCSW

Provider Business Mailing Address
First Line	:	3059 EDGEWOOD CT
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-2593
Country	:	US
Telephone Number	:	205-240-0498
Fax Number	:	706-327-5294

Provider Business Practice Location Address
First Line	:	3059 EDGEWOOD CT
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-2593
Country	:	US
Telephone Number	:	205-240-0498
Fax Number	:

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

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	09/01/2023

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