Provider Demographics
NPI:1114304110
Name:PICKL, COLBI RAE
Entity Type:Individual
Prefix:
First Name:COLBI
Middle Name:RAE
Last Name:PICKL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COLBI
Other - Middle Name:RAE
Other - Last Name:WOOLLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:473 E. CARNEGIE DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408
Mailing Address - Country:US
Mailing Address - Phone:909-235-6042
Mailing Address - Fax:
Practice Address - Street 1:473 E. CARNEGIE DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:909-235-6042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical