Provider Demographics
NPI:1023344678
Name:ROBERSON, DARLENE D (MED)
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:D
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12647 GALVESTON CT STE 120
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-8673
Mailing Address - Country:US
Mailing Address - Phone:730-731-2260
Mailing Address - Fax:866-844-4356
Practice Address - Street 1:12032 BANK BEAVER CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-5510
Practice Address - Country:US
Practice Address - Phone:703-791-3636
Practice Address - Fax:866-844-4356
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-0600333101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool