Healthcare Provider Details

I. General information

NPI: 1760465314
Provider Name (Legal Business Name): JANICE EILEEN ROLLINS-DEAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WEEOT WAY
ARCATA CA
95521-4734
US

IV. Provider business mailing address

1145 JOANNA CT
MCKINLEYVILLE CA
95519-3947
US

V. Phone/Fax

Practice location:
  • Phone: 707-825-5060
  • Fax: 707-825-6753
Mailing address:
  • Phone: 707-839-9566
  • Fax: 707-825-6753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 17198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: