Healthcare Provider Details

I. General information

NPI: 1275751711
Provider Name (Legal Business Name): JAMES BRYAN MCCOLLOM LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRYAN MCCOLLOM LCSW-C

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8930 STANFORD BLVD.
COLUMBIA MD
21046
US

IV. Provider business mailing address

8930 STANFORD BLVD.
COLUMBIA MD
21045
US

V. Phone/Fax

Practice location:
  • Phone: 410-313-6202
  • Fax: 410-313-6212
Mailing address:
  • Phone: 410-313-6202
  • Fax: 410-313-6212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06538
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: