Provider Demographics
NPI:1891092359
Name:ROLLINS, MARLON R (LMHC)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:R
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8373 LAKESHORE TRAIL EAST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4654
Mailing Address - Country:US
Mailing Address - Phone:317-258-1854
Mailing Address - Fax:
Practice Address - Street 1:8373 LAKESHORE TRAIL EAST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4654
Practice Address - Country:US
Practice Address - Phone:317-258-1854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002083A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health