Provider Demographics
NPI:1275751711
Name:MCCOLLOM, JAMES BRYAN (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BRYAN
Last Name:MCCOLLOM
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:MR
Other - First Name:BRYAN
Other - Middle Name:
Other - Last Name:MCCOLLOM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:8930 STANFORD BLVD.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:410-313-6202
Mailing Address - Fax:410-313-6212
Practice Address - Street 1:8930 STANFORD BLVD.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046
Practice Address - Country:US
Practice Address - Phone:410-313-6202
Practice Address - Fax:410-313-6212
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD065381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical