Provider Demographics
NPI:1205012788
Name:ROLLINS COUNSELING LLC
Entity Type:Organization
Organization Name:ROLLINS COUNSELING LLC
Other - Org Name:LIFE JOURNEY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:214-868-0016
Mailing Address - Street 1:2801 REGAL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6315
Mailing Address - Country:US
Mailing Address - Phone:214-868-0016
Mailing Address - Fax:
Practice Address - Street 1:2801 REGAL RD
Practice Address - Street 2:SUITE 105
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1470460Medicaid