Provider Demographics
NPI:1083169130
Name:COLLINS, ROXSANNA (PHD ED-TLLP)
Entity Type:Individual
Prefix:MISS
First Name:ROXSANNA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHD ED-TLLP
Other - Prefix:MS
Other - First Name:ROXSANNA
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD ED-TLLP
Mailing Address - Street 1:165 E GRAND BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4038
Mailing Address - Country:US
Mailing Address - Phone:313-971-2410
Mailing Address - Fax:
Practice Address - Street 1:2727 2ND AVE STE 123A
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2680
Practice Address - Country:US
Practice Address - Phone:313-462-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171M00000X
247200000X, 390200000X
MI6352000654103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program