Healthcare Provider Details

I. General information

NPI: 1588394753
Provider Name (Legal Business Name): DYLAN JAMES COLSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date: 09/27/2022
Reactivation Date: 10/27/2022

III. Provider practice location address

1812 TWIN RIVERS CT
CHESTER VA
23836-2918
US

IV. Provider business mailing address

1812 TWIN RIVERS CT
CHESTER VA
23836-2918
US

V. Phone/Fax

Practice location:
  • Phone: 804-215-6989
  • Fax:
Mailing address:
  • Phone: 804-215-6989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0718000667
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17625
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701014518
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-28512
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: