Doctor Name: | MS. NICOLE ANNE ROBERTSON |
NPI Number: | 1093140253 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 178009320 |
Business Practice Address: | 320 S Locust St Carlinville, IL - 626261648 |
Business Phone Number: | 2178543166 |
Business Fax Number: | 2178549729 |
Mailing Address: | 320 S Locust St, CARLINVILLE |
State: | IL |
Postal Code: | 626261648 |
Phone Number: | 2178543166 |
Fax Number: | 2178549729 |
NPI Enumeration Date: | 09/06/2013 |
NPI Last Update Date: | 09/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 178009320 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |