Provider Demographics
NPI:1164946927
Name:MCCOLLUM, LIANNA CAROLYN
Entity Type:Individual
Prefix:MS
First Name:LIANNA
Middle Name:CAROLYN
Last Name:MCCOLLUM
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 1:4112 COPPERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-1802
Mailing Address - Country:US
Mailing Address - Phone:757-809-7300
Mailing Address - Fax:
Practice Address - Street 1:4112 COPPERFIELD DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-1802
Practice Address - Country:US
Practice Address - Phone:757-809-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer