Active NPI
Leanette S Roberson, MA LPC
- Counselor
- Tifton, GA
National Provider Identifier
1003982752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 003870
- Practice address
- 1603 Mallard Lane
Tifton, GA 31793 - Phone
- (229) 386-2976
- NPI assigned
- Nov 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 003870 | GA | Primary |
Addresses
Primary practice location
1603 Mallard Lane
Tifton, GA 31793
Mailing address
1603 Mallard Lane
Tifton, GA 31793
Phone (229) 386-2976
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003870 | GA | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003982752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1603 MALLARD LANE",
"city": "TIFTON",
"state": "GA",
"postal_code": "31793",
"telephone_number": "229-386-2976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1603 MALLARD LANE",
"city": "TIFTON",
"state": "GA",
"postal_code": "31793",
"telephone_number": "229-386-2976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERSON",
"first_name": "LEANETTE",
"middle_name": "S",
"credential": "MA LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "GA",
"license": "003870",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tifton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.