Provider Demographics
NPI:1386179299
Name:MCCOLLOUGH, SHARON
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:MCCOLLOUGH
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 1:3219 PHELPS LN FL 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-3735
Mailing Address - Country:US
Mailing Address - Phone:410-302-2177
Mailing Address - Fax:410-488-1144
Practice Address - Street 1:3219 PHELPS LANE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229
Practice Address - Country:US
Practice Address - Phone:410-302-2177
Practice Address - Fax:410-488-1144
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health