Provider Demographics
NPI:1235204223
Name:COLLINS, CAMERON KIRKLAND (PHD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:KIRKLAND
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 1:1012 SALEM ST NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-2136
Mailing Address - Country:US
Mailing Address - Phone:252-299-1652
Mailing Address - Fax:
Practice Address - Street 1:2261 NASH ST NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896
Practice Address - Country:US
Practice Address - Phone:252-237-8403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102692103T00000X
NC3513103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist