Provider Demographics
NPI:1194270223
Name:ROBERTSON, JASON (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 RAMSEY ST STE 10
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4705
Mailing Address - Country:US
Mailing Address - Phone:910-424-2020
Mailing Address - Fax:
Practice Address - Street 1:726 RAMSEY ST STE 10
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4705
Practice Address - Country:US
Practice Address - Phone:910-424-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0109331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical