Provider Demographics
NPI:1053636589
Name:COLLINS-RAWLS, STEPHANIE LAYTRAIL (LPC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LAYTRAIL
Last Name:COLLINS-RAWLS
Suffix:
Gender:F
Credentials:LPC
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 307
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-0307
Mailing Address - Country:US
Mailing Address - Phone:478-230-2439
Mailing Address - Fax:
Practice Address - Street 1:436 HENRY WAY LN
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-1275
Practice Address - Country:US
Practice Address - Phone:478-230-2439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-27
Last Update Date:2010-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional