Provider Demographics
NPI:1609247717
Name:MCCOLLUM, SYLVIA (LMT)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:SYLVIA
Other - Middle Name:CRAWFORD
Other - Last Name:MCCOLLUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:102 DARRYL LN
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:SC
Mailing Address - Zip Code:29525-4441
Mailing Address - Country:US
Mailing Address - Phone:843-586-9857
Mailing Address - Fax:843-586-7942
Practice Address - Street 1:102 DARRYL LN
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:SC
Practice Address - Zip Code:29525-4441
Practice Address - Country:US
Practice Address - Phone:843-586-9857
Practice Address - Fax:843-586-7942
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6863247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other