Individual
LEANETTE S ROBERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LPC
Contact information
Practice address
1603 MALLARD LANE, TIFTON, GA 31793
(229) 386-2976
Mailing address
1603 MALLARD LANE, TIFTON, GA 31793
(229) 386-2976
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
003870
GA
Other
Enumeration date
11/27/2006
Last updated
07/08/2007
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