Provider Demographics
NPI:1124484928
Name:ROBERTS, LAUREN ADELE (MS, LPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ADELE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ROBERTS
Other - Last Name:STIDGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 WILLIAMS AVE SW STE 221
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6001
Mailing Address - Country:US
Mailing Address - Phone:256-508-5803
Mailing Address - Fax:
Practice Address - Street 1:303 WILLIAMS AVE SW STE 221
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6001
Practice Address - Country:US
Practice Address - Phone:256-508-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3751101YP2500X, 101YM0800X
ALC2514A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL101YP2500XOtherLPC
AL3751OtherLPC