Provider Demographics
NPI:1013732098
Name:ROLLINS, BROOKE (LSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 MEADOWDALE DR
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-7610
Mailing Address - Country:US
Mailing Address - Phone:419-340-4330
Mailing Address - Fax:
Practice Address - Street 1:1100 BEECHER XING N STE D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-4565
Practice Address - Country:US
Practice Address - Phone:614-881-5804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.08003451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical