Provider Demographics
NPI:1285967695
Name:DR. L. WAYNE ROBERTSON
Entity type:Organization
Organization Name:DR. L. WAYNE ROBERTSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:252-586-4205
Mailing Address - Street 1:158 DRUMGOLD RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NC
Mailing Address - Zip Code:27850-9415
Mailing Address - Country:US
Mailing Address - Phone:252-586-4205
Mailing Address - Fax:252-586-4205
Practice Address - Street 1:158 DRUMGOLD RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NC
Practice Address - Zip Code:27850-9415
Practice Address - Country:US
Practice Address - Phone:252-586-4205
Practice Address - Fax:252-586-4205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHSP-P 1252251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHSP-P 1252OtherNORTH CAROLINA PSYCHOLOGY BOARD