Provider Demographics
NPI:1447040118
Name:ROLLE, LOGAN ELIZABETH (APCC)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:ELIZABETH
Last Name:ROLLE
Suffix:
Gender:
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3889 LONG ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7581
Mailing Address - Country:US
Mailing Address - Phone:805-742-6831
Mailing Address - Fax:805-540-5884
Practice Address - Street 1:3889 LONG ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7581
Practice Address - Country:US
Practice Address - Phone:805-742-6831
Practice Address - Fax:805-540-5884
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16872101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional