Provider Demographics
NPI:1255450045
Name:ROBERTS, KRISTIN LOUISE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:LOUISE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-3816
Mailing Address - Country:US
Mailing Address - Phone:865-774-2444
Mailing Address - Fax:865-774-4235
Practice Address - Street 1:419 HIGH ST
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3816
Practice Address - Country:US
Practice Address - Phone:865-774-2444
Practice Address - Fax:865-774-4235
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNIP5411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3691656Medicaid
TN3691656Medicaid