Provider Demographics
NPI:1417042755
Name:COLLINS, LAURA FOSTER (MFT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:FOSTER
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 D ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3757
Mailing Address - Country:US
Mailing Address - Phone:415-456-1684
Mailing Address - Fax:415-456-3013
Practice Address - Street 1:706 D ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3757
Practice Address - Country:US
Practice Address - Phone:415-456-1684
Practice Address - Fax:415-456-3013
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16846106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist