Provider Demographics
NPI:1992733471
Name:ROBERTS, BETTY V (LPC)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:V
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:BETTY
Other - Middle Name:V
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1344 US HIGHWAY 19 S
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-4867
Mailing Address - Country:US
Mailing Address - Phone:229-436-6004
Mailing Address - Fax:229-888-3340
Practice Address - Street 1:2501 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1735
Practice Address - Country:US
Practice Address - Phone:229-259-4139
Practice Address - Fax:229-259-4925
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003634101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional