Provider Demographics
NPI:1477101830
Name:ROLLINS, SETH ROBERT (LPCC)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:ROBERT
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-1877
Mailing Address - Country:US
Mailing Address - Phone:419-238-1695
Mailing Address - Fax:419-238-1007
Practice Address - Street 1:1229 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-1877
Practice Address - Country:US
Practice Address - Phone:419-238-1695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OHE.2404113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0387459Medicaid
OH16145387OtherCAQH