Healthcare Provider Details

I. General information

NPI: 1881598902
Provider Name (Legal Business Name): COLLEY SOCIAL WORK SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13017 LITTLE BLUFF PL
VANCLEAVE MS
39565-7170
US

IV. Provider business mailing address

13017 LITTLE BLUFF PL
VANCLEAVE MS
39565-7170
US

V. Phone/Fax

Practice location:
  • Phone: 228-623-0512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. COLETHA DESHAY COLLEY
Title or Position: SOCIAL WORKER/OWNER
Credential: LCSW
Phone: 228-623-0512