Provider Demographics
NPI:1386205540
Name:COLLINS, CARRIE JEAN (MS, CAC)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:JEAN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 YARBORO ST
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-3626
Mailing Address - Country:US
Mailing Address - Phone:843-229-0409
Mailing Address - Fax:
Practice Address - Street 1:238 S COIT ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4422
Practice Address - Country:US
Practice Address - Phone:843-665-9349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)