Provider Demographics
NPI:1275819880
Name:ROLLINS, CRYSTAL (BCBA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-0306
Mailing Address - Country:US
Mailing Address - Phone:808-927-4927
Mailing Address - Fax:
Practice Address - Street 1:400 ALA MAKANI ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3533
Practice Address - Country:US
Practice Address - Phone:808-793-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor