Provider Demographics
NPI:1326170788
Name:COLLINS, CAROLE YARBENET (PSYCHOTHERAPIST LICE)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:YARBENET
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PSYCHOTHERAPIST LICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 HENNING DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106
Mailing Address - Country:US
Mailing Address - Phone:336-723-1161
Mailing Address - Fax:336-748-0720
Practice Address - Street 1:2735 HENNING DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106
Practice Address - Country:US
Practice Address - Phone:336-723-1161
Practice Address - Fax:336-748-0720
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC917101Y00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC917OtherLICENSED PROFESSIONAL COU