Provider Demographics
NPI:1245333616
Name:ROLLEN, JAMES LEON JR (CSAC II LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEON
Last Name:ROLLEN
Suffix:JR
Gender:M
Credentials:CSAC II LCSW
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:#43 CALLE DE SILENCIO
Mailing Address - Street 2:CASA DE SERINIDAD
Mailing Address - City:YONA
Mailing Address - State:GU
Mailing Address - Zip Code:96915
Mailing Address - Country:US
Mailing Address - Phone:671-789-2838
Mailing Address - Fax:
Practice Address - Street 1:680 DAMON RD
Practice Address - Street 2:
Practice Address - City:TOTO
Practice Address - State:GU
Practice Address - Zip Code:96915
Practice Address - Country:US
Practice Address - Phone:617-477-5256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO353101YA0400X
MO0013941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical