Healthcare Provider Details

I. General information

NPI: 1215369657
Provider Name (Legal Business Name): PAMELA TERESA MCCOLLUM-BUTLER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 G ST SE
WASHINGTON DC
20003-2883
US

IV. Provider business mailing address

9714 THORNVILLE DR
FORT WASHINGTON MD
20744-3957
US

V. Phone/Fax

Practice location:
  • Phone: 202-547-3837
  • Fax:
Mailing address:
  • Phone: 301-741-2637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number25960
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: