Provider Demographics
NPI:1679041032
Name:COLBORN, MARYANN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:
Last Name:COLBORN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 S MAY AVE APT 1223
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-9022
Mailing Address - Country:US
Mailing Address - Phone:301-871-5150
Mailing Address - Fax:
Practice Address - Street 1:7452 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3547
Practice Address - Country:US
Practice Address - Phone:410-766-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11024101YM0800X, 101YP2500X
MDLGP9104101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC11024OtherMARYLAND BOARD OF PROFESSIONAL COUNSELORS AND THERAPISTS
MD101YP2500XMedicaid
MD1679041032Medicaid