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General NPI Number Information
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NPI Number | 1942441951
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Entity Type | Organization
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Legal Business Name | S COLLICOTT INCORPORATED
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Dates
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Enumeration Date | 03/20/2009
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Last Update Date | 03/20/2009
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Provider Practice Location Address
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Address Line | 43288 JOY LN
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City | HOLLYWOOD
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State | MD
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Zip | 20636-2608
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Country | US
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Telephone | 301-643-3769
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Fax | 301-884-7018
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Provider Business Mailing Address
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Address Line | PO BOX 76
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City | CHARLOTTE HALL
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State | MD
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Zip | 20622-0076
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Country | US
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Telephone | 301-643-3769
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Fax | 301-884-7018
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHEILA F. COLLICOTT
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Credential | PSY.D.
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Telephone | 301-643-3769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 04018
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License Number State | MD
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