Provider Demographics
NPI:1033688403
Name:ROLLOCKS, JAMARRI M (CAADC, MATS)
Entity Type:Individual
Prefix:
First Name:JAMARRI
Middle Name:M
Last Name:ROLLOCKS
Suffix:
Gender:F
Credentials:CAADC, MATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 COOPER LAKE RD SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1921
Mailing Address - Country:US
Mailing Address - Phone:404-944-9425
Mailing Address - Fax:
Practice Address - Street 1:197 COOPER LAKE RD SE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-1921
Practice Address - Country:US
Practice Address - Phone:404-944-9425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012067101YP2500X
GAC0261101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty