Provider Demographics
NPI:1972117877
Name:COLLUM, SARAH ALLISON (MS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ALLISON
Last Name:COLLUM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 POWERS FERRY RD SE STE 100
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9489
Mailing Address - Country:US
Mailing Address - Phone:770-565-3045
Mailing Address - Fax:770-565-3046
Practice Address - Street 1:3581 HABERSHAM AT NORTHLAKE BLDG M
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4001
Practice Address - Country:US
Practice Address - Phone:470-569-5942
Practice Address - Fax:470-569-5945
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-20-129133106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician