Provider Demographics
NPI:1366796062
Name:TWILA ROULHAC
Entity type:Organization
Organization Name:TWILA ROULHAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTERS LEVEL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TWILA
Authorized Official - Middle Name:ALISA
Authorized Official - Last Name:ROULHAC
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:850-628-7847
Mailing Address - Street 1:5639 CARDINAL RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLTON
Mailing Address - State:FL
Mailing Address - Zip Code:32426-6902
Mailing Address - Country:US
Mailing Address - Phone:850-628-7847
Mailing Address - Fax:
Practice Address - Street 1:2711 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-1366
Practice Address - Country:US
Practice Address - Phone:850-769-6001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X0251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health