Provider Demographics
NPI:1407533037
Name:ROLLINS, TAYLOR DANIELLE (APCC 13546)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DANIELLE
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:APCC 13546
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 CAMBRIA AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5950
Mailing Address - Country:US
Mailing Address - Phone:559-718-3779
Mailing Address - Fax:
Practice Address - Street 1:3636 N 1ST ST STE 162
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6869
Practice Address - Country:US
Practice Address - Phone:559-476-2166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YP2500XMedicaid