Individual
MR. PAUL CHARLES MCCOLLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
10077 DOGWOOD ST NW STE 110, COON RAPIDS, MN 55448-5285
(651) 777-5222
Mailing address
14300 34TH AVE N APT 338, PLYMOUTH, MN 55447-5207
(716) 380-8177
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305758
MN
Other
Enumeration date
02/06/2023
Last updated
09/07/2024
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