Provider Demographics
NPI:1306296504
Name:MCCOLLUM, SOPHIE (LCSW)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 JAQUET DR
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2814
Mailing Address - Country:US
Mailing Address - Phone:713-997-0766
Mailing Address - Fax:
Practice Address - Street 1:5311 KIRBY DR
Practice Address - Street 2:SUITE 204
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1364
Practice Address - Country:US
Practice Address - Phone:713-997-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX554521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical