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General NPI Number Information
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NPI Number | 1215098850
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Entity Type | Individual
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Provider Name | GREGORY ROBERT ROLNICK MA
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 840 SE 8TH AVE SUITE 204
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City | OAK HARBOR
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State | WA
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Zip | 98277
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Country | US
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Telephone | 360-679-2020
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Fax | 360-679-2020
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Provider Business Mailing Address
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Address Line | 840 SE 8TH AVE SUITE 204
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City | OAK HARBOR
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State | WA
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Zip | 98277
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Country | US
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Telephone | 360-679-2020
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Fax | 360-679-2020
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | LF00001070
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LF00001070
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License Number State | WA
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