Provider Demographics
NPI:1902264294
Name:ROBERTS, EVELYN NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:NICOLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:NICOLE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3059 EDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-2593
Mailing Address - Country:US
Mailing Address - Phone:205-240-0498
Mailing Address - Fax:706-327-5294
Practice Address - Street 1:3059 EDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-2593
Practice Address - Country:US
Practice Address - Phone:205-240-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor