Provider Demographics
NPI:1437663705
Name:ROLLINS, TOSHA DIANNE (LPC)
Entity Type:Individual
Prefix:
First Name:TOSHA
Middle Name:DIANNE
Last Name:ROLLINS
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 1:207 APPLE DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:SC
Mailing Address - Zip Code:29657-9370
Mailing Address - Country:US
Mailing Address - Phone:864-551-5984
Mailing Address - Fax:
Practice Address - Street 1:405A E 1ST AVE
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3062
Practice Address - Country:US
Practice Address - Phone:864-777-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-25
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC.7576PC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional