Provider Demographics
NPI:1417395104
Name:DILLARD, ROLAN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ROLAN
Middle Name:
Last Name:DILLARD
Suffix:
Gender:M
Credentials:MSW, LCSW
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 44
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77353-0044
Mailing Address - Country:US
Mailing Address - Phone:281-660-9305
Mailing Address - Fax:209-231-3801
Practice Address - Street 1:40512 WARIALDA TRCE
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4573
Practice Address - Country:US
Practice Address - Phone:281-660-9305
Practice Address - Fax:209-231-3801
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059771041C0700X
CA798941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical