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Individual

MRS. BRENDA GAIL ROBERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
416 N LAFAYETTE ST, SHELBY, NC 28150-4425
(704) 482-7395
(704) 482-7396
Mailing address
3719 CENTERGROVE RD, CONCORD, NC 28025-7808
(704) 782-7996
(704) 782-7996

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C001260
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2864116A
MEDICARE PROVIDER ID
NC
01
54139
BCBS PROVIDER NUMBER
NC
05
6003061
NC
Enumeration date
10/06/2006
Last updated
07/09/2007
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