Healthcare Provider Details

I. General information

NPI: 1821728205
Provider Name (Legal Business Name): SAMANTHA ROLLING RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 AZALEA RD
MOBILE AL
36609-1515
US

IV. Provider business mailing address

669 AZALEA RD
MOBILE AL
36609-1515
US

V. Phone/Fax

Practice location:
  • Phone: 251-422-1827
  • Fax:
Mailing address:
  • Phone: 251-422-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-211361
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: