Healthcare Provider Details

I. General information

NPI: 1780254813
Provider Name (Legal Business Name): ADAM W ROLAND LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOME RD
COVINGTON KY
41011-5634
US

IV. Provider business mailing address

200 HOME RD
COVINGTON KY
41011-5634
US

V. Phone/Fax

Practice location:
  • Phone: 859-261-8768
  • Fax: 859-291-2431
Mailing address:
  • Phone: 859-261-8768
  • Fax: 859-291-2431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255290
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: