Provider Demographics
NPI:1215369657
Name:MCCOLLUM-BUTLER, PAMELA TERESA (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:TERESA
Last Name:MCCOLLUM-BUTLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9714 THORNVILLE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-3957
Mailing Address - Country:US
Mailing Address - Phone:301-741-2637
Mailing Address - Fax:
Practice Address - Street 1:714 G ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2883
Practice Address - Country:US
Practice Address - Phone:202-547-3837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC25960101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool