Provider Demographics
NPI:1710875919
Name:COLLEY, COLETHA DESHAY (DSW, LMSW)
Entity type:Individual
Prefix:DR
First Name:COLETHA
Middle Name:DESHAY
Last Name:COLLEY
Suffix:
Gender:F
Credentials:DSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13017 LITTLE BLUFF PL
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-7170
Mailing Address - Country:US
Mailing Address - Phone:228-623-0512
Mailing Address - Fax:
Practice Address - Street 1:13017 LITTLE BLUFF PL
Practice Address - Street 2:
Practice Address - City:VANCLEAVE
Practice Address - State:MS
Practice Address - Zip Code:39565-7170
Practice Address - Country:US
Practice Address - Phone:228-623-0512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM5007104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker