Healthcare Provider Details

I. General information

NPI: 1982259750
Provider Name (Legal Business Name): PAMELA M. COLBERT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 N DUTTON AVE STE 105
SANTA ROSA CA
95401-7121
US

IV. Provider business mailing address

4415 SONOMA HWY STE G
SANTA ROSA CA
95409-4165
US

V. Phone/Fax

Practice location:
  • Phone: 707-568-2300
  • Fax:
Mailing address:
  • Phone: 707-481-6838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: