Provider Demographics
NPI:1508998519
Name:ROLLINS, MARTHA HOPE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:HOPE
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 N BLOODWORTH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1231
Mailing Address - Country:US
Mailing Address - Phone:919-239-4588
Mailing Address - Fax:919-516-0558
Practice Address - Street 1:827 N BLOODWORTH ST
Practice Address - Street 2:SUITE A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1231
Practice Address - Country:US
Practice Address - Phone:919-239-4588
Practice Address - Fax:919-516-0558
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0003451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP84186Medicaid
NCP84186Medicaid