Basic Information
| Provider Information | |||||||||
| NPI: | 1659746840 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBERTSON | ||||||||
| FirstName: | ARKERIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12097 OLD HAMMOND HWY STE I3 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708168679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252836260 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9270 SIEGEN LN | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708101998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2254423540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2015 | ||||||||
| LastUpdateDate: | 04/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 84733 | TX | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 6630 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 3535785 | 05 | LA | MEDICAID |