Provider Demographics
NPI:1881465607
Name:ROLLINGS, SANDRA DEE (LMSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:DEE
Last Name:ROLLINGS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 W HAVENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-5001
Mailing Address - Country:US
Mailing Address - Phone:615-924-4600
Mailing Address - Fax:
Practice Address - Street 1:2009 W HAVENWOOD AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-5001
Practice Address - Country:US
Practice Address - Phone:615-924-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID44551104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker