Provider Demographics
NPI:1174845523
Name:BAKER-ROLLIN, ASHONDA (LPPC-S)
Entity Type:Individual
Prefix:
First Name:ASHONDA
Middle Name:
Last Name:BAKER-ROLLIN
Suffix:
Gender:F
Credentials:LPPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5156
Mailing Address - Country:US
Mailing Address - Phone:602-770-3589
Mailing Address - Fax:
Practice Address - Street 1:320 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6373
Practice Address - Country:US
Practice Address - Phone:740-387-5210
Practice Address - Fax:740-375-0331
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1300011-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional