Provider Demographics
NPI:1467748566
Name:COLLINS, SAMANTHA LEIGH (LPC, NCC, MAC, CADC)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPC, NCC, MAC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 METHODIST RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-8006
Mailing Address - Country:US
Mailing Address - Phone:843-520-6101
Mailing Address - Fax:
Practice Address - Street 1:691 METHODIST RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-8006
Practice Address - Country:US
Practice Address - Phone:843-520-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5244101YP2500X
ORC6437101YP2500X
PAPC015758P101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional