Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 0710102892 | VA |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 13850 | NC |
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 802342 | GA |
NPI | 1427448836 |
---|---|
Provider Name | Dr. Famika Lashell Robertson |
First Address | Mableton, GA 30126-3363 |
Second Address | Mableton, GA 30126-3363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2015 |
Last Update Date | 24/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0 | N/A (01) | |
20618 | DOT-SUBSTANCE ABUSE PROFESSIONAL (01) | GA |
3058-R | CAC-II GEORGIA (01) | GA |
4567 | CISD TRAUMA SPECIALIST (01) | GA |
4567 | NRC SUBSTANCE ABUSE EXPERT (01) | GA |
CERT 683 | LIFE COACH (01) | GA |
CSAC-0710102892 | CERTIFIED SUBSTANCE ABUSE COUNSELOR (01) | VA |
CSAC-13850 | CERTIFIED SUBSTANCE ABUSE COUNSELOR (01) | NC |
ICADC-802342 | IC/RC ALCOHOL DRUG COUNSELOR (01) | NC |
NAMS1 | NATIONAL ANGER MANAGEMENT SPECIALIST (01) | GA |