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General NPI Number Information
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NPI Number | 1790931152
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Entity Type | Individual
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Provider Name | GRACE R. ROLEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/16/2008
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Last Update Date | 08/16/2008
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Provider Practice Location Address
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Address Line | 118 VETERANS DR
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City | RICHLANDS
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State | VA
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Zip | 24641-2764
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Country | US
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Telephone | 276-596-9360
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Fax | 276-596-9361
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Provider Business Mailing Address
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Address Line | 103 VISTA ST
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City | BLUEFIELD
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State | VA
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Zip | 24605-1515
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Country | US
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Telephone | 276-326-3220
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904002768
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License Number State | VA
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