Provider Demographics
NPI:1073565032
Name:COLLINGS, LINDA JOAN (PHD, MP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JOAN
Last Name:COLLINGS
Suffix:
Gender:F
Credentials:PHD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 ASBURY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-6511
Mailing Address - Country:US
Mailing Address - Phone:985-624-2942
Mailing Address - Fax:504-910-9980
Practice Address - Street 1:633 ASBURY DR
Practice Address - Street 2:SUITE A
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6511
Practice Address - Country:US
Practice Address - Phone:985-624-2942
Practice Address - Fax:504-910-9980
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA848103TC0700X
LAMP.0020103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P09644Medicare UPIN
LA4B478Medicare ID - Type Unspecified