Provider Demographics
NPI:1265044432
Name:COLLINS, SHAWNITA AMBER
Entity Type:Individual
Prefix:
First Name:SHAWNITA
Middle Name:AMBER
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 1:2700 NEABSCO COMMON PL APT 242
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6779
Mailing Address - Country:US
Mailing Address - Phone:571-991-8769
Mailing Address - Fax:
Practice Address - Street 1:2700 NEABSCO COMMON PL APT 242
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-6779
Practice Address - Country:US
Practice Address - Phone:571-991-8769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst