Provider Demographics
NPI:1356624449
Name:COLCLOUGH, JULIA B (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:B
Last Name:COLCLOUGH
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275A PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-1356
Mailing Address - Country:US
Mailing Address - Phone:803-494-9812
Mailing Address - Fax:
Practice Address - Street 1:1275A PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-1356
Practice Address - Country:US
Practice Address - Phone:803-494-9812
Practice Address - Fax:803-494-4260
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRC 23360175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath