Provider Demographics
NPI:1730866187
Name:GOLLAPALI, ROSALYN
Entity type:Individual
Prefix:
First Name:ROSALYN
Middle Name:
Last Name:GOLLAPALI
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 1:2595 HUMMINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-9430
Mailing Address - Country:US
Mailing Address - Phone:517-477-0057
Mailing Address - Fax:
Practice Address - Street 1:2595 HUMMINGBIRD DR
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-9430
Practice Address - Country:US
Practice Address - Phone:517-477-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4151001103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist