Organization
CHANGES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROLLAND NICOLAS MSW (CLINICIAN)
(321) 591-3248
Entity
Organization
Contact information
Practice address
1156 LAMPLIGHTER DR NW, PALM BAY, FL 32907-7936
(321) 591-3248
Mailing address
1156 LAMPLIGHTER DR NW, PALM BAY, FL 32907-7936
(321) 591-3248
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
FL
Other
Enumeration date
12/11/2013
Last updated
12/11/2013
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