Provider Demographics
NPI:1215098850
Name:ROLNICK, GREGORY ROBERT (MA)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ROBERT
Last Name:ROLNICK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 SE 8TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277
Mailing Address - Country:US
Mailing Address - Phone:360-679-2020
Mailing Address - Fax:360-679-2020
Practice Address - Street 1:840 SE 8TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277
Practice Address - Country:US
Practice Address - Phone:360-679-2020
Practice Address - Fax:360-679-2020
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001070103TC2200X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health