Provider Demographics
NPI:1184219230
Name:ROLLERSON, ASHLEY ALAINA
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ALAINA
Last Name:ROLLERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4148 WHITSETT AVE.
Mailing Address - Street 2:203
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2453
Mailing Address - Country:US
Mailing Address - Phone:310-487-9327
Mailing Address - Fax:
Practice Address - Street 1:12268 VENTURA BLVD FL 2
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2518
Practice Address - Country:US
Practice Address - Phone:310-487-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty