Provider Demographics
NPI:1306035795
Name:ROBERTSON, SYBIL (LCSW)
Entity type:Individual
Prefix:
First Name:SYBIL
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16425 RAVENCHASE WAY
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-0019
Mailing Address - Country:US
Mailing Address - Phone:804-647-1198
Mailing Address - Fax:804-647-1198
Practice Address - Street 1:5309 COMMONWEALTH CENTRE PKWY STE 401
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2633
Practice Address - Country:US
Practice Address - Phone:804-819-4000
Practice Address - Fax:804-819-4268
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040062911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1306035795Medicaid
VA4945255Medicaid