Provider Demographics
NPI:1447398730
Name:COLLINS, AMALIA CHRISTEEN (ACSW BCD LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMALIA
Middle Name:CHRISTEEN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:ACSW BCD LCSW
Other - Prefix:
Other - First Name:AMALIA
Other - Middle Name:C
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:3169 2ND AVENUE EAST
Practice Address - Street 2:WISE COUNTY BEHAVIORAL HEALTH SERVICES
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219
Practice Address - Country:US
Practice Address - Phone:276-523-8319
Practice Address - Fax:276-523-6964
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002898104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA800002437OtherMEDICARE
VA010149584Medicaid