Provider Demographics
NPI:1053152322
Name:ROBERTS, ALICIA MARIE FLORA (BS)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE FLORA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MARIE FLOR
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:11 NADEAU CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-5157
Mailing Address - Country:US
Mailing Address - Phone:919-622-7992
Mailing Address - Fax:
Practice Address - Street 1:111 MACKENAN DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7903
Practice Address - Country:US
Practice Address - Phone:919-371-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000048725158106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty