Provider Demographics
NPI:1164461471
Name:COLLINS, ROBERT P (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S SHARON AMITY RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2896
Mailing Address - Country:US
Mailing Address - Phone:704-362-1555
Mailing Address - Fax:704-362-0023
Practice Address - Street 1:501 S SHARON AMITY RD
Practice Address - Street 2:SUITE 500
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2896
Practice Address - Country:US
Practice Address - Phone:704-362-1555
Practice Address - Fax:704-362-0023
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC843103T00000X
NC5119103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0370Medicaid
SCQ34053Medicare UPIN