Healthcare Provider Details

I. General information

NPI: 1770429904
Provider Name (Legal Business Name): COLETTE ELISE MCCORD-SNOOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 TOWERS CRESCENT DR FL 13
VIENNA VA
22182-6211
US

IV. Provider business mailing address

1414 N HUDSON ST
ARLINGTON VA
22201-5050
US

V. Phone/Fax

Practice location:
  • Phone: 240-896-5244
  • Fax:
Mailing address:
  • Phone: 571-447-3558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704019097
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: