Provider Demographics
NPI:1831460286
Name:ROLAND, ANDREA LOUISE (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LOUISE
Last Name:ROLAND
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 PARK CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2504
Mailing Address - Country:US
Mailing Address - Phone:952-224-8291
Mailing Address - Fax:952-926-9713
Practice Address - Street 1:3705 PARK CENTER BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2504
Practice Address - Country:US
Practice Address - Phone:952-224-8291
Practice Address - Fax:952-926-9713
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional