Provider Demographics
NPI:1053403287
Name:KOLCUM, VIRGINIA B (LCSW)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:B
Last Name:KOLCUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4850
Mailing Address - Country:US
Mailing Address - Phone:434-962-1842
Mailing Address - Fax:
Practice Address - Street 1:914 E HIGH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4850
Practice Address - Country:US
Practice Address - Phone:434-962-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040047111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945018Medicaid
VA370743OtherANTHEM
VA0804376OtherOPTIMA BEHAVIORAL HEALTH
VA004945018Medicaid