Provider Demographics
NPI:1902099476
Name:ROBERTS, CHRISTOPHER JAMES (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N US HIGHWAY 64
Mailing Address - Street 2:PO BOX 161
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954-9009
Mailing Address - Country:US
Mailing Address - Phone:252-216-9965
Mailing Address - Fax:
Practice Address - Street 1:704 N US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954-9009
Practice Address - Country:US
Practice Address - Phone:252-216-9965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1261101YA0400X
NCC0061081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112007Medicaid