Healthcare Provider Details

I. General information

NPI: 1013439587
Provider Name (Legal Business Name): AMANDA M ROLLISON MS, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA LANGOLF MS, LLP

II. Dates (important events)

Enumeration Date: 07/16/2017
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36216 FREEDOM RD STE 27
FARMINGTON HILLS MI
48335-3002
US

IV. Provider business mailing address

19046 CONNECTICUT ST
ROSEVILLE MI
48066-4114
US

V. Phone/Fax

Practice location:
  • Phone: 248-266-1360
  • Fax:
Mailing address:
  • Phone: 248-266-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6362009631
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: