Individual
COLLEEN NUSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CDCI
Contact information
Practice address
245 N BINKLEY ST STE 200, SOLDOTNA, AK 99669-7500
(907) 714-4521
(907) 260-4063
Mailing address
245 N BINKLEY ST STE 200, SOLDOTNA, AK 99669-7500
(907) 714-4521
(907) 260-4063
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
4053
AK
1041C0700X
Clinical Social Worker
Primary
1290
AK
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMG675
—
AK
Enumeration date
06/17/2008
Last updated
05/19/2022
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