Provider Demographics
NPI:1003870213
Name:COLLINS, KATHRYN JEAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:JEAN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2161
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-7161
Mailing Address - Country:US
Mailing Address - Phone:252-537-6164
Mailing Address - Fax:252-537-9199
Practice Address - Street 1:600 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-7161
Practice Address - Country:US
Practice Address - Phone:252-537-6164
Practice Address - Fax:252-537-9199
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC001315104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003096Medicaid
NC2874098AMedicare ID - Type Unspecified