Provider Demographics
NPI:1649786997
Name:ROHLMAN, LACEY
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:ROHLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 SEA LARK LN
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7406
Mailing Address - Country:US
Mailing Address - Phone:850-710-7199
Mailing Address - Fax:850-939-3945
Practice Address - Street 1:7552 NAVARRE PKWY UNIT 32
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7308
Practice Address - Country:US
Practice Address - Phone:850-939-3944
Practice Address - Fax:850-939-3945
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-18-8570106E00000X
FLRBT-15-07522106S00000X
FL1-23-68906103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician