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General NPI Number Information
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NPI Number | 1780555177
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Entity Type | Individual
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Provider Name | DIERDRA H ROLLER
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Gender | Female
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 8150 BROOKVILLE RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46239-8903
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Country | US
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Telephone | 317-754-7784
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Fax |
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Provider Business Mailing Address
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Address Line | 10308 WOODS EDGE DR
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City | FISHERS
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State | IN
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Zip | 46037-9353
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Country | US
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Telephone | 630-862-1256
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 178.013300
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License Number State | IL
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