Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 895 | NC |
Y | 103TC0700X | Clinical Psychologist | 895 | NC |
N | 103TC1900X | Counseling Psychologist | 895 | NC |
NPI | 1033198841 |
---|---|
Provider Name | Dr. Marion Gamble Mccollum |
First Address | Greensboro, NC 27401-1513 |
Second Address | Greensboro, NC 27401-1513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 10/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033198841 | (02) | NC |