Healthcare Provider Details

I. General information

NPI: 1457344699
Provider Name (Legal Business Name): DR. MARNEE SWOPE COLBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MARY MARJORIE SWOPE PHD

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 JAMESTOWN RD STE 105
WILLIAMSBURG VA
23185-3362
US

IV. Provider business mailing address

1313 JAMESTOWN RD STE 105
WILLIAMSBURG VA
23185-3362
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-1462
  • Fax: 757-253-0061
Mailing address:
  • Phone: 757-253-1462
  • Fax: 757-253-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810001091
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: