Individual
THOMAS L MCCOLLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1206 HIGHWAY 411, VONORE, TN 37885-2455
(423) 884-7271
(423) 884-3277
Mailing address
1009 RIDGEWAY PL, STE 100, FARMINGTON, NM 87401-2092
(423) 442-2622
(423) 442-5760
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-10660
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11261845
CAQH
—
05
—
3921436
—
TN
Enumeration date
07/14/2005
Last updated
09/27/2019
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