Provider Demographics
NPI:1437240538
Name:COLLINS, KATHLEEN ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2124 MAIN ST
Mailing Address - Street 2:SUITE 165
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2405
Mailing Address - Country:US
Mailing Address - Phone:714-536-0077
Mailing Address - Fax:714-434-2675
Practice Address - Street 1:2124 MAIN ST
Practice Address - Street 2:SUITE 165
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2405
Practice Address - Country:US
Practice Address - Phone:714-536-0077
Practice Address - Fax:714-434-2675
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical