Provider Demographics
NPI:1427448836
Name:ROBERTSON, FAMIKA LASHELL (PHD, SAE/SAP,)
Entity type:Individual
Prefix:DR
First Name:FAMIKA
Middle Name:LASHELL
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PHD, SAE/SAP,
Other - Prefix:DR
Other - First Name:F.
Other - Middle Name:LASHELL
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, SAE/SAP
Mailing Address - Street 1:4901 OLDE TOWNE PKWY STE 165
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-5645
Mailing Address - Country:US
Mailing Address - Phone:833-227-2489
Mailing Address - Fax:707-415-7200
Practice Address - Street 1:4901 OLDE TOWNE PKWY STE 165
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-5645
Practice Address - Country:US
Practice Address - Phone:833-227-2489
Practice Address - Fax:770-415-7200
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102892101YA0400X
VA0732008394101YM0800X
GA802342103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4567OtherNRC SUBSTANCE ABUSE EXPERT
NCCSAC-13850OtherCERTIFIED SUBSTANCE ABUSE COUNSELOR
GANAMS1OtherNATIONAL ANGER MANAGEMENT SPECIALIST
GA4567OtherCISD TRAUMA SPECIALIST
GA20618OtherDOT-SUBSTANCE ABUSE PROFESSIONAL
NCICADC-802342OtherIC/RC ALCOHOL DRUG COUNSELOR
VA0732008394OtherQUALIFIED MENTAL HEALTH PROFESSIONAL
GA3058-ROtherCAC-II GEORGIA
VACSAC-0710102892OtherCERTIFIED SUBSTANCE ABUSE COUNSELOR
GACERT 683OtherLIFE COACH