Provider Demographics
NPI:1508234170
Name:ROLL, JUSTIN (LPC, MHSP, CSAT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:ROLL
Suffix:
Gender:M
Credentials:LPC, MHSP, CSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 21ST AVE S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5317
Mailing Address - Country:US
Mailing Address - Phone:615-428-0387
Mailing Address - Fax:
Practice Address - Street 1:2409 21ST AVE S
Practice Address - Street 2:SUITE 102
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5317
Practice Address - Country:US
Practice Address - Phone:615-428-0387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-12
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional