Provider Demographics
NPI:1669661476
Name:ROLL, CELINE B (LAC)
Entity Type:Individual
Prefix:MS
First Name:CELINE
Middle Name:B
Last Name:ROLL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16013 COMUS RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-9121
Mailing Address - Country:US
Mailing Address - Phone:301-349-2984
Mailing Address - Fax:301-349-0704
Practice Address - Street 1:16013 COMUS RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-9121
Practice Address - Country:US
Practice Address - Phone:301-349-2984
Practice Address - Fax:301-349-0704
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00752171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist