Provider Demographics
NPI:1851811285
Name:ROLLINS, RYAN CROCHRAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:CROCHRAN
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 CROOKS RD APT 301
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1342
Mailing Address - Country:US
Mailing Address - Phone:718-809-4240
Mailing Address - Fax:
Practice Address - Street 1:1320 CROOKS RD APT 301
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1342
Practice Address - Country:US
Practice Address - Phone:718-809-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011153801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical