Provider Demographics
NPI:1215549100
Name:ROLLINS, CATIE R
Entity type:Individual
Prefix:
First Name:CATIE
Middle Name:R
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 GREAT LAKES CIR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-2950
Mailing Address - Country:US
Mailing Address - Phone:843-685-4498
Mailing Address - Fax:
Practice Address - Street 1:1200 GREAT LAKES CIR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-2950
Practice Address - Country:US
Practice Address - Phone:843-685-4498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician