MEDICARE: CANDICE ROLLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1588470405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE ROLLE

Provider Business Mailing Address
First Line	:	3911 MARY ELIZA TRCE NW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-1086
Country	:	US
Telephone Number	:	404-500-8694
Fax Number	:

Provider Business Practice Location Address
First Line	:	2487 CEDARCREST RD STE 722
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-2730
Country	:	US
Telephone Number	:	678-631-9907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2024
Last Update Date	:	03/31/2026

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Directions to “ CANDICE ROLLE ” Practice Location

Language	Start Address	Practice Location

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