Provider Demographics
NPI:1437355344
Name:MALLOY, ROLANDA DENISE (LPC)
Entity Type:Individual
Prefix:MISS
First Name:ROLANDA
Middle Name:DENISE
Last Name:MALLOY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 GREENLAND RD
Mailing Address - Street 2:
Mailing Address - City:ELLERBE
Mailing Address - State:NC
Mailing Address - Zip Code:28338-9127
Mailing Address - Country:US
Mailing Address - Phone:910-334-5819
Mailing Address - Fax:
Practice Address - Street 1:315 C SOUTH LONG DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379
Practice Address - Country:US
Practice Address - Phone:910-997-5477
Practice Address - Fax:910-997-5290
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NC7570101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
201429OtherNCC ID #
NC7570OtherNORTH CAROLINA BOARD OF LICENSED PROFESSIONAL COUNSELORS