Healthcare Provider Details

I. General information

NPI: 1033482096
Provider Name (Legal Business Name): LAURA KATHRYN ROLAND-KELLAR M.A., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18631 SE 61ST STREET RD
OCKLAWAHA FL
32179-3459
US

IV. Provider business mailing address

18631 SE 61ST STREET RD
OCKLAWAHA FL
32179-3459
US

V. Phone/Fax

Practice location:
  • Phone: 321-343-7675
  • Fax:
Mailing address:
  • Phone: 321-343-7675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: