Provider Demographics
NPI:1013439587
Name:ROLLISON, AMANDA M (MS, LLP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:M
Last Name:ROLLISON
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:LANGOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LLP
Mailing Address - Street 1:19046 CONNECTICUT ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4114
Mailing Address - Country:US
Mailing Address - Phone:248-266-1360
Mailing Address - Fax:
Practice Address - Street 1:36216 FREEDOM RD STE 27
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-3002
Practice Address - Country:US
Practice Address - Phone:248-266-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-16
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103K00000X
MI6362009631103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst