Provider Demographics
NPI:1376973917
Name:COLLINS, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
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 1:532 MAY ST
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2832
Mailing Address - Country:US
Mailing Address - Phone:805-489-0401
Mailing Address - Fax:
Practice Address - Street 1:1320 VAN BEURDEN DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3380
Practice Address - Country:US
Practice Address - Phone:805-528-8178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45-3114340101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)