Individual
KENNETH RICHARD ROBERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
620 OAK DR, HURST, TX 76053-5526
(254) 258-3057
Mailing address
620 OAK DR, HURST, TX 76053-5526
(254) 258-3057
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14198
TX
Other
Enumeration date
08/11/2020
Last updated
08/11/2020
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