Provider Demographics
NPI:1255843165
Name:COLLINS, MARY C
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 FERRAND ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3249
Mailing Address - Country:US
Mailing Address - Phone:318-342-9979
Mailing Address - Fax:318-342-9980
Practice Address - Street 1:2414 FERRAND ST STE 2
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-342-9979
Practice Address - Fax:318-342-9980
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health