Sandra Roberts, ED.D
Individual provider Active NPI Professional Counselor · Tillman, SC
NPI 1659601458 · NPPES record last updated Dec 30, 2009
Key facts
- NPI
- 1659601458
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 4660 (SC)
- Practice address
- 358 Cedar Crest Dr
Tillman, SC 29943-3006 - Phone
- (843) 726-8460
- NPI assigned
- Dec 30, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5599 | GA | MD | Professional Counselor |
| 4660 | SC | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 4660 | SC | Yes |
| Professional Counselor | 101YP2500X | 5599 | GA |
Addresses
Primary practice location
358 Cedar Crest Dr
Tillman, SC 29943-3006
Mailing address
358 Cedar Crest Dr
Tillman, SC 29943-3006
Phone (843) 726-8460
Other providers in Tillman, SC
All providers in Tillman, SC · Professional Counselor in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.