Healthcare Provider Details

I. General information

NPI: 1174845523
Provider Name (Legal Business Name): ASHONDA BAKER-ROLLIN LPPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 EXECUTIVE DR
MARION OH
43302-6373
US

IV. Provider business mailing address

292 E WASHINGTON AVE
MARION OH
43302-5156
US

V. Phone/Fax

Practice location:
  • Phone: 740-387-5210
  • Fax: 740-375-0331
Mailing address:
  • Phone: 602-770-3589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1300011-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: