Provider Demographics
NPI:1225471212
Name:COLLINS, CAROL J (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S DIXIE HWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5518
Mailing Address - Country:US
Mailing Address - Phone:561-392-0135
Mailing Address - Fax:
Practice Address - Street 1:400 S DIXIE HWY
Practice Address - Street 2:SUITE 410
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5518
Practice Address - Country:US
Practice Address - Phone:561-392-0135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT595106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist