Provider Information for 1902264294
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EVELYN NICOLE ROBERTS LCSW
Other Names:Former Name:EVELYN NICOLE MITCHELLSex: Female
NPI: 1902264294
Last Updated: 2023-09-01
Certification Date: 2023-09-01
Certification Date: 2023-09-01
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1902264294 | ||||||||||||
| Enumeration Date | 2016-02-02 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 3059 EDGEWOOD CT COLUMBUS, GA 31907-2593 United States Phone: 205-240-0498 | Fax:706-327-5294 | ||||||||||||
| Primary Practice Address | 3059 EDGEWOOD CT COLUMBUS, GA 31907-2593 United States Phone: 205-240-0498 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 1600 FORT BENNING RD | ||||||||||||
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