Provider Demographics
NPI:1588394753
Name:COLSON, DYLAN JAMES (LCMHC)
Entity type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:JAMES
Last Name:COLSON
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 TWIN RIVERS CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-2918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1812 TWIN RIVERS CT
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-2918
Practice Address - Country:US
Practice Address - Phone:704-650-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-12
Last Update Date:2025-02-08
Deactivation Date:2022-09-27
Deactivation Code:
Reactivation Date:2022-10-27
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-28512101YA0400X
VA0718000667101YA0400X
NC17625101YM0800X
VA0701014518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)