Provider Demographics
NPI:1093927501
Name:ROLLINS, PAULETTE R (LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:R
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3924 MISSION RIDGE
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5714
Mailing Address - Country:US
Mailing Address - Phone:214-868-0016
Mailing Address - Fax:425-962-0016
Practice Address - Street 1:2801 REGAL RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6315
Practice Address - Country:US
Practice Address - Phone:214-868-0016
Practice Address - Fax:425-962-0016
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1470460Medicaid