Provider Demographics
NPI:1174290274
Name:COLLINS, HEIDI LYN (IMH20399, CAP100128)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:IMH20399, CAP100128
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-7732
Mailing Address - Country:US
Mailing Address - Phone:561-307-5567
Mailing Address - Fax:
Practice Address - Street 1:258 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5355
Practice Address - Country:US
Practice Address - Phone:407-831-2991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH20399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health