Provider Demographics
NPI:1790972412
Name:MCCOLLUM, VIVIAN JUANITA (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:JUANITA
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:230 S JACKSON ST
Mailing Address - Street 2:SUITE 243
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2885
Mailing Address - Country:US
Mailing Address - Phone:229-317-4727
Mailing Address - Fax:229-430-3989
Practice Address - Street 1:230 S JACKSON ST
Practice Address - Street 2:SUITE 243
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2885
Practice Address - Country:US
Practice Address - Phone:229-317-4727
Practice Address - Fax:229-430-3989
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GALPC004750101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional