Provider Demographics
NPI:1366080418
Name:ROLLINS, DENISE CHERELLE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:CHERELLE
Last Name:ROLLINS
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 1:8619 CULPEPPER DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-7658
Mailing Address - Country:US
Mailing Address - Phone:916-607-9685
Mailing Address - Fax:
Practice Address - Street 1:8619 CULPEPPER DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-7658
Practice Address - Country:US
Practice Address - Phone:916-607-9685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA001608198OtherIHSS