Healthcare Provider Details

I. General information

NPI: 1104636257
Provider Name (Legal Business Name): DAVARDO D ROLLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9026 CREEKSTONE LAKE DR
HOUSTON TX
77054-1029
US

IV. Provider business mailing address

9026 CREEKSTONE LAKE DR
HOUSTON TX
77054-1029
US

V. Phone/Fax

Practice location:
  • Phone: 832-491-3318
  • Fax:
Mailing address:
  • Phone: 832-491-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number84331
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: