Provider Demographics
NPI:1235599135
Name:COLLINS, GLORIA COLLEEN (EDD, LPC, NCC, BCTMH)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:COLLEEN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:EDD, LPC, NCC, BCTMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10721 EAGLE NEST RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-9711
Mailing Address - Country:US
Mailing Address - Phone:225-936-2959
Mailing Address - Fax:
Practice Address - Street 1:1508 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3826
Practice Address - Country:US
Practice Address - Phone:228-369-8379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1823101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional