Provider Demographics
NPI:1316030836
Name:ROLLINS, PAMELA (ST)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 2ND AVE N STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3287
Mailing Address - Country:US
Mailing Address - Phone:864-525-1157
Mailing Address - Fax:
Practice Address - Street 1:1016 2ND AVE N STE 102
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3287
Practice Address - Country:US
Practice Address - Phone:843-491-3572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6267235Z00000X
SC3465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3465OtherSPEECH LANGUAGE PATHOLOGY