Individual
MARK L. COLLISTER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
L.S.W.
Contact information
Practice address
435 W 4TH ST, WILLIAMSPORT, PA 17701-6001
(570) 322-7873
(570) 322-8026
Mailing address
10 CATHERINE DR, WILLIAMSPORT, PA 17701-1292
(570) 322-7873
(570) 322-8026
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW124379
PA
Other
Enumeration date
06/08/2006
Last updated
07/08/2007
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