Provider Demographics
NPI:1679602262
Name:ROBERSON, MARCELLE K (BA)
Entity type:Individual
Prefix:MR
First Name:MARCELLE
Middle Name:K
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24762 ROOSEVELT CT
Mailing Address - Street 2:#374
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-1878
Mailing Address - Country:US
Mailing Address - Phone:248-991-1414
Mailing Address - Fax:
Practice Address - Street 1:7310 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3122
Practice Address - Country:US
Practice Address - Phone:313-556-2600
Practice Address - Fax:313-556-2700
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor