Provider Demographics
NPI:1275104069
Name:COLLINS, CAMILLA CAROLYN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:CAROLYN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 WENTZVILLE PKWY STE 114
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3424
Mailing Address - Country:US
Mailing Address - Phone:636-293-0517
Mailing Address - Fax:
Practice Address - Street 1:16 APPALOOSA CT
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-4514
Practice Address - Country:US
Practice Address - Phone:636-293-0517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230155631041C0700X
MO20210132371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical