Provider Demographics
NPI:1184790933
Name:LORD, COLETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:COLETTE
Middle Name:
Last Name:LORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:COLETTE
Other - Middle Name:
Other - Last Name:POEHLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:317 14TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2554
Mailing Address - Country:US
Mailing Address - Phone:858-276-8831
Mailing Address - Fax:858-215-5459
Practice Address - Street 1:317 14TH ST STE E
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2554
Practice Address - Country:US
Practice Address - Phone:858-276-8831
Practice Address - Fax:858-215-5459
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21497103TC0700X
CA21497103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP21497AMedicare PIN