Provider Demographics
NPI:1265004873
Name:COLLINS, CARI (CADC)
Entity Type:Individual
Prefix:
First Name:CARI
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:CARO
Other - Middle Name:
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2323 WINDISH DR
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-9780
Mailing Address - Country:US
Mailing Address - Phone:309-344-2323
Mailing Address - Fax:309-344-4368
Practice Address - Street 1:900 S DEER RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-2639
Practice Address - Country:US
Practice Address - Phone:309-344-2323
Practice Address - Fax:309-344-4368
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL35337261QM0801X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)