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General NPI Number Information
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NPI Number | 1790972412
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Entity Type | Individual
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Provider Name | VIVIAN JUANITA MCCOLLUM PH.D., LPC
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Gender | Female
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 1136 WASHINGTON AVE UNIT 809
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City | SAINT LOUIS
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State | MO
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Zip | 63101-1174
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Country | US
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Telephone | 404-536-7586
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Fax | 314-727-6067
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Provider Business Mailing Address
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Address Line | 1136 WASHINGTON AVE UNIT 809
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City | SAINT LOUIS
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State | MO
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Zip | 63101-1174
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Country | US
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Telephone | 404-536-7586
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Fax | 314-727-6067
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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 | LPC004750
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2015032865
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License Number State | MO
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