Provider Demographics
NPI:1134203581
Name:COLCLOUGH, LINDA (LPC)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:COLCLOUGH
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 1:100 MEMORIAL HOSPITAL DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1199
Mailing Address - Country:US
Mailing Address - Phone:251-344-2762
Mailing Address - Fax:251-344-5492
Practice Address - Street 1:100 MEMORIAL HOSPITAL DR STE 2A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1199
Practice Address - Country:US
Practice Address - Phone:251-344-2762
Practice Address - Fax:251-344-5492
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL LPC 871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510 92662OtherBLUE CROSS
AL515 92982OtherBLUE CROSS