Provider Demographics
NPI:1730546557
Name:MCCOLLUM, THELONIKA CHINA LEE (LMSW)
Entity type:Individual
Prefix:MS
First Name:THELONIKA
Middle Name:CHINA LEE
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1896 LORCA DR APT 89
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6009
Mailing Address - Country:US
Mailing Address - Phone:575-694-8623
Mailing Address - Fax:
Practice Address - Street 1:1896 LORCA DR APT 89
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6009
Practice Address - Country:US
Practice Address - Phone:575-694-8623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-09325104100000X
MELC235201041C0700X
TX652281041C0700X
NMSWB-2024-03151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker