Provider Demographics
NPI:1417975582
Name:COLLINS, ALICIA MARIA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:MARIA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 CARMEL EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8275
Mailing Address - Country:US
Mailing Address - Phone:704-752-8414
Mailing Address - Fax:704-752-8104
Practice Address - Street 1:7401 CARMEL EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8275
Practice Address - Country:US
Practice Address - Phone:704-752-8414
Practice Address - Fax:704-752-8104
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1117106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist