Provider Demographics
NPI:1902283674
Name:ROLLINS, JABRIL (ACSW)
Entity Type:Individual
Prefix:
First Name:JABRIL
Middle Name:
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11222
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90749-1222
Mailing Address - Country:US
Mailing Address - Phone:323-543-2951
Mailing Address - Fax:
Practice Address - Street 1:7003 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042
Practice Address - Country:US
Practice Address - Phone:323-543-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2018-07-10
Deactivation Date:2018-07-06
Deactivation Code:
Reactivation Date:2018-07-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner