Provider Demographics
NPI:1457344699
Name:COLBURN, MARNEE SWOPE
Entity Type:Individual
Prefix:DR
First Name:MARNEE
Middle Name:SWOPE
Last Name:COLBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MARJORIE
Other - Last Name:SWOPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1313 JAMESTOWN RD
Mailing Address - Street 2:STE 105
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3362
Mailing Address - Country:US
Mailing Address - Phone:757-253-1462
Mailing Address - Fax:757-253-0061
Practice Address - Street 1:1313 JAMESTOWN RD
Practice Address - Street 2:STE 105
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3362
Practice Address - Country:US
Practice Address - Phone:757-253-1462
Practice Address - Fax:757-253-0061
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001091103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000629OtherVALUE OPTIONS
VA463812OtherANTHEM
VA080053OtherSENTANA
VA09096OtherCIGNA