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General NPI Number Information
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NPI Number | 1407385321
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Entity Type | Individual
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Provider Name | DIANE L MCCOLLUM M.A., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 06/05/2017
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Provider Practice Location Address
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Address Line | 2940 HORIZON PARK DR
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City | SUWANEE
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State | GA
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Zip | 30024-7251
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Country | US
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Telephone | 678-920-2608
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Fax |
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Provider Business Mailing Address
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Address Line | 3750 TUGGLE RD
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City | BUFORD
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State | GA
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Zip | 30519-4037
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Country | US
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Telephone | 678-920-2608
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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