Provider Demographics
NPI:1255602058
Name:ROLEY, AMY SUZANNE (PCC)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:SUZANNE
Last Name:ROLEY
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2752 ERIE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2207
Mailing Address - Country:US
Mailing Address - Phone:513-540-4893
Mailing Address - Fax:
Practice Address - Street 1:2752 ERIE AVE STE 5
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-2207
Practice Address - Country:US
Practice Address - Phone:513-840-4893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0800283101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional