Provider Demographics
NPI:1376818997
Name:COLLARD, PATRICIA (LMSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:COLLARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:TIBERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4205 CHARLAR DR STE 3
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-6809
Mailing Address - Country:US
Mailing Address - Phone:517-367-0670
Mailing Address - Fax:517-367-0681
Practice Address - Street 1:4205 CHARLAR DR STE 3
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-6809
Practice Address - Country:US
Practice Address - Phone:517-367-0670
Practice Address - Fax:517-367-0681
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68010921611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical