Provider Demographics
NPI:1528769122
Name:ROBERTS, ALONZA DALLAS
Entity type:Individual
Prefix:
First Name:ALONZA
Middle Name:DALLAS
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 TOWNE PARK RD
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-1605
Mailing Address - Country:US
Mailing Address - Phone:202-779-7538
Mailing Address - Fax:
Practice Address - Street 1:4820 TOWNE PARK RD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-1605
Practice Address - Country:US
Practice Address - Phone:202-779-7538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health