Provider Demographics
NPI:1275147035
Name:COLLAND, SALLY LOUISE
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:LOUISE
Last Name:COLLAND
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 1:151 WILDROSE ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4738
Mailing Address - Country:US
Mailing Address - Phone:304-282-3083
Mailing Address - Fax:
Practice Address - Street 1:151 WILDROSE ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4738
Practice Address - Country:US
Practice Address - Phone:304-282-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator