Provider Demographics
NPI:1346518735
Name:ROHALL, VICKI L (LCDC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:ROHALL
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PIRATE DR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5682
Mailing Address - Country:US
Mailing Address - Phone:817-579-4464
Mailing Address - Fax:817-579-9253
Practice Address - Street 1:104 PIRATE DR
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5682
Practice Address - Country:US
Practice Address - Phone:817-579-4464
Practice Address - Fax:817-579-9253
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10187101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)