Provider Demographics
NPI:1669626362
Name:ROLLEY, MICHELLE L (MS, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:L
Last Name:ROLLEY
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N ELDORADO RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7703
Mailing Address - Country:US
Mailing Address - Phone:309-663-2229
Mailing Address - Fax:309-263-9336
Practice Address - Street 1:220 N ELDORADO RD
Practice Address - Street 2:SUITE A
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-7703
Practice Address - Country:US
Practice Address - Phone:309-663-2229
Practice Address - Fax:309-263-9336
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.003072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health