NPIMap

Individual provider Active NPI

Sonya Roselle McCollum, LICSW

  • Clinical Social Worker
  • Clarksville, MD
National Provider Identifier
1316233455
Registry record updated Jun 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
302456 Issued in DC
Practice address
7220 Wolverton CT
Clarksville, MD 21029-1741
Phone
(301) 346-6569
NPI assigned
Jun 28, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 302456 DC Primary
Clinical Social Worker 1041C0700X 08604 MD

Addresses

Primary practice location

7220 Wolverton CT
Clarksville, MD 21029-1741

Mailing address

7220 Wolverton Court
Clarksville, MD 21029
Phone (301) 346-6569

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
302456DCMDClinical Social Worker
08604MDMDOccupational Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309219200000",
    "number": "1316233455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7220 WOLVERTON COURT",
            "city": "CLARKSVILLE",
            "state": "MD",
            "postal_code": "21029",
            "telephone_number": "301-346-6569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7220 WOLVERTON CT",
            "city": "CLARKSVILLE",
            "state": "MD",
            "postal_code": "210291741",
            "telephone_number": "301-346-6569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOLLUM",
        "first_name": "SONYA",
        "middle_name": "ROSELLE",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-28",
        "last_updated": "2011-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "302456",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "08604",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.