Individual
JENNIFER L ROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW-S, LICDC
Contact information
Practice address
3095 KETTERING BLVD, MORAINE, OH 45439-1983
(937) 293-8300
Mailing address
3095 KETTERING BLVD, MORAINE, OH 45439-1983
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDCIII.161339
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.162108
OH
1041C0700X
Clinical Social Worker
Primary
I.1901910
OH
Other
Enumeration date
09/22/2015
Last updated
12/21/2021
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