Provider Demographics
NPI:1619483377
Name:ROLSTON-MARTIN, JOANNE ROBYN (MFT)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:ROBYN
Last Name:ROLSTON-MARTIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4739 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2683
Mailing Address - Country:US
Mailing Address - Phone:818-903-1988
Mailing Address - Fax:
Practice Address - Street 1:4739 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2683
Practice Address - Country:US
Practice Address - Phone:818-903-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152673106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist