Provider Demographics
NPI:1720974447
Name:CHISHOLM, MARJORIE KATE (LCSW)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:KATE
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 DEL ORO CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2202
Mailing Address - Country:US
Mailing Address - Phone:719-238-5716
Mailing Address - Fax:
Practice Address - Street 1:116 DEL ORO CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2202
Practice Address - Country:US
Practice Address - Phone:719-238-5716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099240891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical