Provider Demographics
NPI:1124410709
Name:COLETTE BRUNELL LCSW-C,BCD,LLC
Entity Type:Organization
Organization Name:COLETTE BRUNELL LCSW-C,BCD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C,BCD
Authorized Official - Phone:410-730-6119
Mailing Address - Street 1:5550 STERRETT PL
Mailing Address - Street 2:SUITE 314
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2611
Mailing Address - Country:US
Mailing Address - Phone:410-730-6119
Mailing Address - Fax:410-290-6550
Practice Address - Street 1:5550 STERRETT PL
Practice Address - Street 2:SUITE 314
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2611
Practice Address - Country:US
Practice Address - Phone:410-730-6119
Practice Address - Fax:410-290-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05994251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management