Provider Demographics
NPI:1184298242
Name:ARIZA-MCCOLL, BRENNA
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:ARIZA-MCCOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:
Other - Last Name:MCCOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWA
Mailing Address - Street 1:13 DRAKESWAY CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2042
Mailing Address - Country:US
Mailing Address - Phone:336-655-2253
Mailing Address - Fax:
Practice Address - Street 1:2003 E NC HIGHWAY 54 STE C
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2483
Practice Address - Country:US
Practice Address - Phone:919-682-5300
Practice Address - Fax:919-692-5322
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO131771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical