Provider Demographics
NPI:1265842819
Name:COLLINS, CHRISTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 STONE TRAIL ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-3533
Mailing Address - Country:US
Mailing Address - Phone:713-689-4603
Mailing Address - Fax:903-252-6008
Practice Address - Street 1:1115 JAYCEE DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-5802
Practice Address - Country:US
Practice Address - Phone:713-689-4603
Practice Address - Fax:903-252-6008
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX411391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical