Provider Demographics
NPI:1346257607
Name:COLLINS, CAROL JEAN (LCPC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JEAN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83606-0075
Mailing Address - Country:US
Mailing Address - Phone:208-454-3825
Mailing Address - Fax:
Practice Address - Street 1:117 S 9TH AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-3754
Practice Address - Country:US
Practice Address - Phone:208-454-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-30101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional