Healthcare Provider Details

I. General information

NPI: 1194737494
Provider Name (Legal Business Name): LORI GUNNER KOLLE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WOOD HILL RD
ROCKVILLE MD
20850-8724
US

IV. Provider business mailing address

200 WOOD HILL RD
ROCKVILLE MD
20850-8724
US

V. Phone/Fax

Practice location:
  • Phone: 301-838-4200
  • Fax: 301-309-2596
Mailing address:
  • Phone: 301-838-4200
  • Fax: 301-309-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number05944
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0904001916
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: