Provider Demographics
NPI:1528210200
Name:ROELANT, DEBORAH MAE (LICENSED INDEP SOCI)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:MAE
Last Name:ROELANT
Suffix:
Gender:F
Credentials:LICENSED INDEP SOCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 RIFFEL ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691
Mailing Address - Country:US
Mailing Address - Phone:330-345-3461
Mailing Address - Fax:330-345-3462
Practice Address - Street 1:365 RIFFEL ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691
Practice Address - Country:US
Practice Address - Phone:330-345-3461
Practice Address - Fax:330-345-3462
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0007724SUPV101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)