Provider Demographics
NPI:1780759662
Name:ROBERTS, DEBRA KIM (PHD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:KIM
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PERIMETER CENTER PKWY NE
Mailing Address - Street 2:SUITE 910
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-1308
Mailing Address - Country:US
Mailing Address - Phone:770-350-3500
Mailing Address - Fax:770-350-3510
Practice Address - Street 1:211 PERIMETER CENTER PKWY NE
Practice Address - Street 2:SUITE 910
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-1308
Practice Address - Country:US
Practice Address - Phone:770-350-3500
Practice Address - Fax:770-350-3510
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002616103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical