Provider Demographics
NPI:1396475141
Name:ROBERTS, CHARLES ELDON (LPC-S)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ELDON
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12160 ABRAMS RD STE 502
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4649
Mailing Address - Country:US
Mailing Address - Phone:469-608-9850
Mailing Address - Fax:
Practice Address - Street 1:12160 ABRAMS RD STE 502
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4649
Practice Address - Country:US
Practice Address - Phone:469-608-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health