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General NPI Number Information
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NPI Number | 1083112809
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Entity Type | Individual
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Provider Name | MRS. JAMIE KOLLER
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Gender | Female
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 01/26/2018
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Provider Practice Location Address
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Address Line | 400 S WATER ST
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-4942
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Country | US
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Telephone | 252-333-4569
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Fax |
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Provider Business Mailing Address
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Address Line | 507 SEAVIEW DR
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City | EDENTON
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State | NC
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Zip | 27932-9269
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A13569
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License Number State | NC
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