Provider Demographics
NPI:1073039566
Name:ROLLAND, LYNETTE (PHD)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:ROLLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5862 SYLVIA DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1132
Mailing Address - Country:US
Mailing Address - Phone:504-813-5357
Mailing Address - Fax:504-486-2623
Practice Address - Street 1:5862 SYLVIA DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-1132
Practice Address - Country:US
Practice Address - Phone:504-813-5357
Practice Address - Fax:504-486-2623
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA624103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool