Provider Demographics
NPI:1801850185
Name:KUMIA, COLLEEN R (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:R
Last Name:KUMIA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 S DOBSON RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5661
Mailing Address - Country:US
Mailing Address - Phone:480-706-9559
Mailing Address - Fax:480-820-6254
Practice Address - Street 1:1845 S DOBSON RD
Practice Address - Street 2:SUITE 207
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5661
Practice Address - Country:US
Practice Address - Phone:480-706-9559
Practice Address - Fax:480-820-6254
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSW-365711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ820580346OtherPROVIDER TAXONOMY CODE