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General NPI Number Information
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NPI Number | 1336343961
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Entity Type | Individual
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Provider Name | LAURA L COLVIN MED
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Gender | Female
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 300 SUNSET RD SUITE 102
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City | BURLINGTON
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State | NJ
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Zip | 08016-3625
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Country | US
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Telephone | 609-239-8300
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Fax | 609-239-8333
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Provider Business Mailing Address
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Address Line | PO BOX 149
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City | RANCOCAS
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State | NJ
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Zip | 08073-0149
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Country | US
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Telephone | 609-239-8300
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Fax | 609-239-8333
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | NJ
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