Provider Demographics
NPI:1013493469
Name:MCCOLL, STEPHANIE RITA (LPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RITA
Last Name:MCCOLL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-7596
Mailing Address - Country:US
Mailing Address - Phone:609-822-1108
Mailing Address - Fax:609-822-1106
Practice Address - Street 1:JEWISH FAMILY SERVICE
Practice Address - Street 2:607 N. JEROME AVE
Practice Address - City:MARGATE CITY
Practice Address - State:NJ
Practice Address - Zip Code:08402
Practice Address - Country:US
Practice Address - Phone:609-822-1108
Practice Address - Fax:609-822-1106
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00634300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health