Provider Demographics
NPI:1386220408
Name:COLSTON, SUE E
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:E
Last Name:COLSTON
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 1:1357 BLACKS BLUFF RD SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-4318
Mailing Address - Country:US
Mailing Address - Phone:170-626-6933
Mailing Address - Fax:
Practice Address - Street 1:106 E 5TH AVE STE B
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3128
Practice Address - Country:US
Practice Address - Phone:706-509-0130
Practice Address - Fax:706-237-6503
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional