Provider Demographics
NPI:1508554668
Name:ROLLINS, ALEXIS MICHELLE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MICHELLE
Last Name:ROLLINS
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 1:1200 5TH AVE N APT 1505
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BCH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-5926
Mailing Address - Country:US
Mailing Address - Phone:843-957-5084
Mailing Address - Fax:
Practice Address - Street 1:1200 5TH AVE N APT 1505
Practice Address - Street 2:
Practice Address - City:SURFSIDE BCH
Practice Address - State:SC
Practice Address - Zip Code:29575-5926
Practice Address - Country:US
Practice Address - Phone:843-957-5084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician