Provider Demographics
NPI:1275884330
Name:ROLLINSON, RANDALL SEAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:SEAN
Last Name:ROLLINSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:R.
Other - Middle Name:SEAN
Other - Last Name:ROLLINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:202 E EARLL DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2634
Mailing Address - Country:US
Mailing Address - Phone:602-819-2657
Mailing Address - Fax:
Practice Address - Street 1:202 E EARLL DR
Practice Address - Street 2:STE. 160
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2634
Practice Address - Country:US
Practice Address - Phone:480-471-8560
Practice Address - Fax:888-979-8197
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional