Provider Demographics
NPI:1114304110
Name:PICKL, COLBI RAE
Entity type:Individual
Prefix:
First Name:COLBI
Middle Name:RAE
Last Name:PICKL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COLBI
Other - Middle Name:RAE
Other - Last Name:WOOLLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1096 CALIMESA BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-1563
Mailing Address - Country:US
Mailing Address - Phone:909-235-6042
Mailing Address - Fax:909-760-5383
Practice Address - Street 1:1096 CALIMESA BLVD STE 207
Practice Address - Street 2:
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320-1563
Practice Address - Country:US
Practice Address - Phone:909-235-6042
Practice Address - Fax:909-760-5383
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical