Provider Demographics
NPI:1396312666
Name:ROBERTS, ALEXANDER RYAN (MED, LAPC)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:RYAN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MED, LAPC
Other - Prefix:MR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:879 N POINT DR APT B
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-8706
Mailing Address - Country:US
Mailing Address - Phone:419-617-9087
Mailing Address - Fax:
Practice Address - Street 1:3103 CLAIRMONT RD NE STE B
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1043
Practice Address - Country:US
Practice Address - Phone:404-636-1457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health