Individual
MARY R. ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
825 FAIRFAX AVE STE 710, NORFOLK, VA 23507-1914
(757) 446-5888
(757) 446-5918
Mailing address
PO BOX 936, NORFOLK, VA 23501-0936
(757) 446-5888
(757) 446-5918
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701003086
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
089353
SENTARA
VA
01
—
287533
ANTHEM HMO HEALTHKEEPERS MENTAL HEALTH PROVIDER NETWORK
VA
01
—
461637
ANTHEM
VA
05
—
4945425
—
VA
Enumeration date
08/12/2010
Last updated
01/19/2018
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