Provider Demographics
NPI:1891884623
Name:COLBURN, BRUCE W (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:W
Last Name:COLBURN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 OYSTER POINT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-6014
Mailing Address - Country:US
Mailing Address - Phone:757-243-2657
Mailing Address - Fax:
Practice Address - Street 1:525 OYSTER POINT RD
Practice Address - Street 2:SUITE B
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-6014
Practice Address - Country:US
Practice Address - Phone:757-243-2657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001225103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist