Provider Demographics
NPI:1841787587
Name:TYLER, ROSLYN
Entity Type:Individual
Prefix:MRS
First Name:ROSLYN
Middle Name:
Last Name:TYLER
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 1:2330 GRACE ST
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2733
Mailing Address - Country:US
Mailing Address - Phone:803-810-0074
Mailing Address - Fax:
Practice Address - Street 1:2330 GRACE ST
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2733
Practice Address - Country:US
Practice Address - Phone:803-810-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC82-52223743OtherCOUNSELIN
SC1841787587OtherFEE FOR SERVICES