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Provider Information for 1952635591


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CHANDRA COLVIN LICSW


Sex: Female

NPI: 1952635591
Last Updated: 2016-11-17
Certification Date:

Details

NameValue
NPI1952635591
Enumeration Date2009-09-30
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 7310 OLIVE BRANCH WAY
LAUREL, MD 20707-6918
United States

Phone: 202-425-6345 | Fax:
 
Primary Practice Address 7310 OLIVE BRANCH WAY
LAUREL, MD 20707-3017
United States

Phone: 202-425-6345 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalDCLC50077718