| Doctor Name: | GARY TYRONE COLLINS |
| NPI Number: | 1639107329 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW, LPC, CCAC |
| License Number: | 02-322 |
| Business Practice Address: | 787 Virginia Ave Welch, WV - 248012341 |
| Business Phone Number: | 3044362106 |
| Business Fax Number: | 3044366362 |
| Mailing Address: | 200 12th Street Ext, PRINCETON |
| State: | WV |
| Postal Code: | 247402329 |
| Phone Number: | 3044259541 |
| Fax Number: | 3044251332 |
| NPI Enumeration Date: | 06/29/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 02-322 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | WV |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |