Provider Demographics
NPI:1700101920
Name:CHISHOLM, COLIN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:CHISHOLM
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3563 ARCHES CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-7422
Mailing Address - Country:US
Mailing Address - Phone:775-530-8607
Mailing Address - Fax:
Practice Address - Street 1:626 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1606
Practice Address - Country:US
Practice Address - Phone:775-241-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT862-LCSW1041C0700X
NV6206-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical