Healthcare Provider Details

I. General information

NPI: 1508752890
Provider Name (Legal Business Name): TAIWANA MACHELLE ROLLINS BACHELOR PSYCHOLOGY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LUCERN AVE APT 3
MODESTO CA
95350-6061
US

IV. Provider business mailing address

1100 LUCERN AVE APT 3
MODESTO CA
95350-6061
US

V. Phone/Fax

Practice location:
  • Phone: 408-600-8216
  • Fax:
Mailing address:
  • Phone: 408-600-8216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: