Provider Demographics
NPI:1477055416
Name:ROLLEFSON, CRYSTAL (MA COUNSELING)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:ROLLEFSON
Suffix:
Gender:F
Credentials:MA COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99-060 KAUHALE ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4136
Mailing Address - Country:US
Mailing Address - Phone:808-646-1978
Mailing Address - Fax:
Practice Address - Street 1:99-060 KAUHALE ST
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4136
Practice Address - Country:US
Practice Address - Phone:808-646-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician