Provider Demographics
NPI:1295397776
Name:COLLINS, CAROLINE L
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:L
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 1:415 KNOLLCREST DR STE 101
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0181
Mailing Address - Country:US
Mailing Address - Phone:530-392-4399
Mailing Address - Fax:530-903-4226
Practice Address - Street 1:415 KNOLLCREST DR STE 101
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0181
Practice Address - Country:US
Practice Address - Phone:530-392-4399
Practice Address - Fax:530-903-4226
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC6645101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health