Provider Demographics
NPI:1972366490
Name:ROCKSTAR WELLNESS LLC
Entity Type:Organization
Organization Name:ROCKSTAR WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGSHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC, SUD, LADC
Authorized Official - Phone:402-515-5059
Mailing Address - Street 1:511 W SIERRA WAY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6034
Mailing Address - Country:US
Mailing Address - Phone:402-515-5059
Mailing Address - Fax:509-381-3536
Practice Address - Street 1:8619 N DIVISION ST STE B
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5944
Practice Address - Country:US
Practice Address - Phone:140-251-5505
Practice Address - Fax:509-381-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770032526OtherNPI