Provider Demographics
NPI:1366138885
Name:COLLAMER, PAULICHIA
Entity type:Individual
Prefix:
First Name:PAULICHIA
Middle Name:
Last Name:COLLAMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAULICHIA
Other - Middle Name:
Other - Last Name:WOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2775 N STATE HIGHWAY 360 APT 1638
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-7836
Mailing Address - Country:US
Mailing Address - Phone:254-459-9644
Mailing Address - Fax:
Practice Address - Street 1:201 E DEBBIE LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2924
Practice Address - Country:US
Practice Address - Phone:817-914-3251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX662591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical