Individual
JERMAINE MCCOLLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
598 BROADWAY FL 2, NEW YORK, NY 10012-3363
(212) 966-9537
Mailing address
598 BROADWAY, NEW YORK, NY 10012-3351
(718) 785-7124
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/04/2015
Last updated
11/04/2015
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