Doctor Name: | MRS. ROSELLE ROBERSON |
NPI Number: | 1629108618 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., L.P.C. |
License Number: | P0512073 |
Business Practice Address: | 1101 W 3rd St Fordyce, AR - 717423014 |
Business Phone Number: | 8703525122 |
Business Fax Number: | 8703525127 |
Mailing Address: | 1101 W 3rd St, FORDYCE |
State: | AR |
Postal Code: | 717423014 |
Phone Number: | 8703525122 |
Fax Number: | 8703525127 |
NPI Enumeration Date: | 03/07/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | P0512073 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |