Provider Demographics
NPI:1265493324
Name:ROLSTON, CYNTHIA D (PHD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:D
Last Name:ROLSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:D
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:ECU PHYSICIANS
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 JOHNS HOPKINS DR
Practice Address - Street 2:ECU PHYSICIANS PSYCHIATRIC MEDICINE
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7225
Practice Address - Country:US
Practice Address - Phone:252-744-1406
Practice Address - Fax:252-744-2419
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3137103TC0700X
VA0810004372103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000854Medicaid
NC046T3OtherBCBS
NC2822600AMedicare ID - Type UnspecifiedMEDICARE PROVIDER #