Provider Demographics
NPI:1164461661
Name:COLLINS, NORMAN LEE (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:LEE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 CLIFFDALE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2126
Mailing Address - Country:US
Mailing Address - Phone:910-488-3615
Mailing Address - Fax:910-483-9449
Practice Address - Street 1:6245 CLIFFDALE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2126
Practice Address - Country:US
Practice Address - Phone:910-488-3615
Practice Address - Fax:910-483-9449
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO1351101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC60-02091Medicaid
NC2868608Medicare ID - Type Unspecified