Active NPI
Deedra J Roberts, ALC
- Professional Counselor
- Montgomery, AL
National Provider Identifier
1205557337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- ALC04174
- Practice address
- 600 Interstate Park Dr Ste 603
Montgomery, AL 36109-5423 - Phone
- (334) 386-0858
- NPI assigned
- Sep 7, 2022
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | ALC04174 | AL | Primary |
Addresses
Primary practice location
600 Interstate Park Dr Ste 603
Montgomery, AL 36109-5423
Mailing address
PO Box 11087
Montgomery, AL 36111-0087
Phone (344) 811-5993
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ALC04174 | AL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662508800000",
"number": "1205557337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 11087",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "361110087",
"telephone_number": "344-811-5993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 INTERSTATE PARK DR STE 603",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "361095423",
"telephone_number": "334-386-0858"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "DEEDRA",
"middle_name": "J",
"credential": "ALC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-07",
"last_updated": "2022-09-07",
"certification_date": "2022-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AL",
"license": "ALC04174",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.