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Organization
MIA ROLDAN AUSTIN THERAPY PLLC
Active
Organization
MIA ROLDAN AUSTIN THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNA-MARIE CHRISTINA ROLDAN LCSW, LCDC (OWNER)
(512) 413-0239
Entity
Organization
Contact information
Practice address
4101 MEDICAL PKWY STE 109, AUSTIN, TX 78756-3724
(512) 413-0239
Mailing address
6104 SHOAL CREEK BLVD, AUSTIN, TX 78757-3130
(512) 413-0239
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790130318
NPI TYPE 1
—
Enumeration date
02/08/2019
Last updated
06/11/2019
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