Provider Demographics
NPI:1598085599
Name:ROLLINS, LORRAINE RASP (PHD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:RASP
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:LORRAINE
Other - Middle Name:MARIE
Other - Last Name:RASP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2200 E. RIVER RD.
Mailing Address - Street 2:SUITE 121
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6579
Mailing Address - Country:US
Mailing Address - Phone:520-577-3652
Mailing Address - Fax:520-577-3516
Practice Address - Street 1:2200 E. RIVER RD.
Practice Address - Street 2:SUITE 121
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6579
Practice Address - Country:US
Practice Address - Phone:520-577-3652
Practice Address - Fax:520-577-3516
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ798103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist