Provider Demographics
NPI:1477072551
Name:ROLLE, TANISHA
Entity Type:Individual
Prefix:MRS
First Name:TANISHA
Middle Name:
Last Name:ROLLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ROCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-5340
Mailing Address - Country:US
Mailing Address - Phone:910-584-5777
Mailing Address - Fax:
Practice Address - Street 1:30 ROCHESTER ST
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-5340
Practice Address - Country:US
Practice Address - Phone:910-584-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0117531041C0700X
NCC0147421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical