Provider Demographics
NPI:1164935912
Name:COLLETON, PENNIE L (NCC, LPC, LCADC)
Entity Type:Individual
Prefix:MS
First Name:PENNIE
Middle Name:L
Last Name:COLLETON
Suffix:
Gender:F
Credentials:NCC, LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747
Mailing Address - Country:US
Mailing Address - Phone:732-829-9896
Mailing Address - Fax:
Practice Address - Street 1:6 SECOND STREET
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-0774
Practice Address - Country:US
Practice Address - Phone:732-744-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00326100101YA0400X
NJ37PC00610100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)