Provider Demographics
NPI:1730377375
Name:ROBERTS, DALE L (MA)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 EAGLES NEST DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-8388
Mailing Address - Country:US
Mailing Address - Phone:919-498-6236
Mailing Address - Fax:919-498-6236
Practice Address - Street 1:120 PROVIDENCE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2273
Practice Address - Country:US
Practice Address - Phone:919-721-7320
Practice Address - Fax:919-498-6236
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6624101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health