Provider Demographics
NPI:1518361070
Name:ROLLINS, JARID PATRICK (LCSW)
Entity Type:Individual
Prefix:
First Name:JARID
Middle Name:PATRICK
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 E VALLEY RD
Mailing Address - Street 2:UNIT 102
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8352
Mailing Address - Country:US
Mailing Address - Phone:970-927-4666
Mailing Address - Fax:
Practice Address - Street 1:1450 E VALLEY RD
Practice Address - Street 2:UNIT 102
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8352
Practice Address - Country:US
Practice Address - Phone:970-920-5555
Practice Address - Fax:970-920-5557
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099246871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical