Provider Demographics
NPI:1356746853
Name:COLBERT, WILLA M (MA, NCC)
Entity type:Individual
Prefix:MRS
First Name:WILLA
Middle Name:M
Last Name:COLBERT
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6378 VICTOR GRAY CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3451
Mailing Address - Country:US
Mailing Address - Phone:703-922-0761
Mailing Address - Fax:
Practice Address - Street 1:2255 CRAIN HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3164
Practice Address - Country:US
Practice Address - Phone:301-292-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health