Provider Demographics
NPI:1740277334
Name:COLBERT, PAMELA Q (LCSWC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:Q
Last Name:COLBERT
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 PATUXENT QUARTER RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10801 HICKORY RIDGE RD STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3871
Practice Address - Country:US
Practice Address - Phone:443-472-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10947101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD081N961FMedicare ID - Type Unspecified
MD61735701OtherCAREFIRST
216009OtherALLIANCE
239518OtherCOMPSYCHE
MD081N961FMedicare ID - Type Unspecified
MDLW80OtherCAREFIRST
DC28670009OtherCAREFIRST
7873422 PPOOtherAUSHC