Doctor Name: | MR. CALVIN COLLINS |
NPI Number: | 1144570250 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMHC |
License Number: | 11397 |
Business Practice Address: | 12543 Tamiami Trl S North Port, FL - 342871446 |
Business Phone Number: | 9412371199 |
Business Fax Number: | |
Mailing Address: | 12543 Tamiami Trl S, NORTH PORT |
State: | FL |
Postal Code: | 342871446 |
Phone Number: | 9412371199 |
Fax Number: | |
NPI Enumeration Date: | 09/16/2012 |
NPI Last Update Date: | 09/17/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 11397 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |