Provider Demographics
NPI:1710782578
Name:PIERRE, ROSELINE
Entity type:Individual
Prefix:
First Name:ROSELINE
Middle Name:
Last Name:PIERRE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15411 W. WADDELL RD
Mailing Address - Street 2:STE.102/ #1263
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379
Mailing Address - Country:US
Mailing Address - Phone:602-800-3992
Mailing Address - Fax:
Practice Address - Street 1:7972 W. THUNDERBIRD RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:602-800-3992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 171400000X, 324500000X, 251S00000X
AZRN136295163WC0400X
AZ251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No171400000XOther Service ProvidersHealth & Wellness Coach
No251B00000XAgenciesCase Management
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility