Provider Demographics
NPI:1114408895
Name:PETTIGREW, ROSLYNN (LCSW)
Entity type:Individual
Prefix:
First Name:ROSLYNN
Middle Name:
Last Name:PETTIGREW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 HOLLOW OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77050-3717
Mailing Address - Country:US
Mailing Address - Phone:281-682-6806
Mailing Address - Fax:
Practice Address - Street 1:6515 HOLLOW OAKS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77050-3717
Practice Address - Country:US
Practice Address - Phone:281-682-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX509651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical