Provider Demographics
NPI:1194860742
Name:COLGAN, KIMBERLEY ANN (LPCMH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:ANN
Last Name:COLGAN
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:ANN
Other - Last Name:FEENEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:380 MERCER MILL RD
Mailing Address - Street 2:
Mailing Address - City:LANDENBERG
Mailing Address - State:PA
Mailing Address - Zip Code:19350-9606
Mailing Address - Country:US
Mailing Address - Phone:610-274-3451
Mailing Address - Fax:302-733-0701
Practice Address - Street 1:226 W PARK PL STE 6
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4516
Practice Address - Country:US
Practice Address - Phone:302-733-0700
Practice Address - Fax:302-733-0701
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000345101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health