Provider Demographics
NPI:1750536249
Name:ROLL, ERNEST (LCPC)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:
Last Name:ROLL
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 CROSS COUNTRY BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3701
Mailing Address - Country:US
Mailing Address - Phone:410-585-0497
Mailing Address - Fax:
Practice Address - Street 1:6204 CROSS COUNTRY BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3701
Practice Address - Country:US
Practice Address - Phone:410-585-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC 2668101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional