Provider Demographics
NPI:1881887701
Name:MACADAM, COLLEEN MARIE (MFT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:MACADAM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1773
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-4773
Mailing Address - Country:US
Mailing Address - Phone:707-235-4526
Mailing Address - Fax:
Practice Address - Street 1:1350 HAYES ST STE B100
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2970
Practice Address - Country:US
Practice Address - Phone:707-235-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43153106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist