Provider Demographics
NPI:1205381639
Name:ROBERTS, JOAN CARLENE (LPC)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:CARLENE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W TRADE ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-2609
Mailing Address - Country:US
Mailing Address - Phone:864-609-7461
Mailing Address - Fax:
Practice Address - Street 1:211 W TRADE ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2609
Practice Address - Country:US
Practice Address - Phone:864-609-7461
Practice Address - Fax:864-228-7691
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6399101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional