Provider Demographics
NPI:1093138398
Name:WELLER, ROLAND
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:
Last Name:WELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROLAND
Other - Middle Name:
Other - Last Name:WELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS CAC III
Mailing Address - Street 1:6475 OLD WADSWORTH BLVD
Mailing Address - Street 2:SUITE # 324
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-4437
Mailing Address - Country:US
Mailing Address - Phone:303-467-2624
Mailing Address - Fax:303-431-8410
Practice Address - Street 1:6475 OLD WADSWORTH BLVD
Practice Address - Street 2:SUITE # 324
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-4437
Practice Address - Country:US
Practice Address - Phone:303-467-2624
Practice Address - Fax:303-431-8410
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006103101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)