Basic Information
| Provider Information | |||||||||
| NPI: | 1306980404 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CSAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 HERITAGE WAY N.E. | ||||||||
| Address2: | SUITE 302 LOUDOUN COUNTY CSB | ||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201764544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037715100 | ||||||||
| FaxNumber: | 7037770170 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 HERITAGE WAY NE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201764544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037715100 | ||||||||
| FaxNumber: | 7037710170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 07/21/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 0710000531 | VA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.