Provider Demographics
NPI:1194737494
Name:KOLLE, LORI GUNNER (LCSW-C)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:GUNNER
Last Name:KOLLE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WOOD HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8724
Mailing Address - Country:US
Mailing Address - Phone:301-838-4200
Mailing Address - Fax:301-309-2596
Practice Address - Street 1:200 WOOD HILL RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8724
Practice Address - Country:US
Practice Address - Phone:301-838-4200
Practice Address - Fax:301-309-2596
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05944104100000X
VA0904001916104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD530196598OtherTRICARE
MD235751OtherKAISER
MD54974OtherUBH
MD901301600Medicaid
MD132205OtherMHN
MD156610000OtherMAGELLAN
DCA2840039OtherBCBS OF DC
MD5144277OtherAETNA
MD235751OtherKAISER