Provider Demographics
NPI:1487639829
Name:COLLINS, THOMAS (LPC CSW CAC I)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:LPC CSW CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1903
Mailing Address - Country:US
Mailing Address - Phone:906-482-9440
Mailing Address - Fax:906-482-9440
Practice Address - Street 1:920 WATER STREET
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930
Practice Address - Country:US
Practice Address - Phone:906-487-9377
Practice Address - Fax:906-487-9538
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010625081041C0700X
MI64010068471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI800003070OtherRAILROAD MEDICARE