Provider Demographics
NPI:1073819926
Name:COLLINS, NICOLE O (MA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:O
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:O
Other - Last Name:CAMBRIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:5843 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1063
Mailing Address - Country:US
Mailing Address - Phone:732-642-4412
Mailing Address - Fax:
Practice Address - Street 1:5843 WATERS EDGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1063
Practice Address - Country:US
Practice Address - Phone:732-642-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist