Provider Demographics
NPI:1578644423
Name:MCCOLLUM, TAMIKO THAMES (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMIKO
Middle Name:THAMES
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 LELIA DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4828
Mailing Address - Country:US
Mailing Address - Phone:601-965-5727
Mailing Address - Fax:
Practice Address - Street 1:412 EDGEWOOD XING
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2957
Practice Address - Country:US
Practice Address - Phone:601-824-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM53741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical