Provider Demographics
NPI:1679732937
Name:ROLDAN, CARLA M (LPC)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:M
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 CREEKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-5236
Mailing Address - Country:US
Mailing Address - Phone:832-265-8168
Mailing Address - Fax:
Practice Address - Street 1:2011 CREEKSHIRE DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-5236
Practice Address - Country:US
Practice Address - Phone:832-265-8168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173524301Medicaid