Provider Demographics
NPI:1154959542
Name:ROLAND, JONATHAN (BCBA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:ROLAND
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12521 CROWN PARK CT APT 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-7461
Mailing Address - Country:US
Mailing Address - Phone:781-805-5119
Mailing Address - Fax:
Practice Address - Street 1:13310 S RIDGE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4961
Practice Address - Country:US
Practice Address - Phone:781-805-5119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265EMedicaid