Provider Demographics
NPI:1770025488
Name:ROLLINS, KHEOMI
Entity Type:Individual
Prefix:
First Name:KHEOMI
Middle Name:
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 VICTORY POINT ST
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-3024
Mailing Address - Country:US
Mailing Address - Phone:702-817-0372
Mailing Address - Fax:
Practice Address - Street 1:5909 VICTORY POINT ST
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-3024
Practice Address - Country:US
Practice Address - Phone:702-789-8466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health