Provider Demographics
NPI:1912252008
Name:ROBERTS, CAROL CONSTANCE (LCPC)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:CONSTANCE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 SWEENEY CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6712
Mailing Address - Country:US
Mailing Address - Phone:406-210-3512
Mailing Address - Fax:406-543-6777
Practice Address - Street 1:1800 S 3RD ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2244
Practice Address - Country:US
Practice Address - Phone:406-210-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional