Provider Demographics
NPI:1699416792
Name:MCCOLLUM, SARAH JOY
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JOY
Last Name:MCCOLLUM
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 1:161 S OLD BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-4504
Mailing Address - Country:US
Mailing Address - Phone:706-799-6976
Mailing Address - Fax:
Practice Address - Street 1:1120 MARKS CHURCH RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2670
Practice Address - Country:US
Practice Address - Phone:706-868-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health