Provider Demographics
NPI:1285417550
Name:ROLLOCKS, BRIEANNA
Entity type:Individual
Prefix:
First Name:BRIEANNA
Middle Name:
Last Name:ROLLOCKS
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 1:1537 LINCOLN WAY APT 303
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-5824
Mailing Address - Country:US
Mailing Address - Phone:908-220-7577
Mailing Address - Fax:
Practice Address - Street 1:131 ELDEN ST STE 302
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4851
Practice Address - Country:US
Practice Address - Phone:703-496-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000472106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst