Provider Demographics
NPI:1851048607
Name:ROLL, CHRYSTAL LYNETTE (LSW)
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:LYNETTE
Last Name:ROLL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-2723
Mailing Address - Country:US
Mailing Address - Phone:775-234-5239
Mailing Address - Fax:775-490-4766
Practice Address - Street 1:783 BASQUE WAY STE 111
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7981
Practice Address - Country:US
Practice Address - Phone:775-234-5239
Practice Address - Fax:775-490-4766
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11570C1041C0700X
NV9184-M104100000X
NV6741-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker